Healthcare Provider Details

I. General information

NPI: 1124455142
Provider Name (Legal Business Name): SEATTLE BEHAVIOR CONSULTING & THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4746 11TH AVE NE SUITE 102
SEATTLE WA
98105-4657
US

IV. Provider business mailing address

4746 11TH AVE NE SUITE 102
SEATTLE WA
98105-4657
US

V. Phone/Fax

Practice location:
  • Phone: 206-535-8876
  • Fax: 206-486-9938
Mailing address:
  • Phone: 206-535-8876
  • Fax: 206-486-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-09-5509
License Number State

VIII. Authorized Official

Name: DR. MARA KATRA OBLAK
Title or Position: OWNER/BEHAVIOR ANALYST
Credential: PHD, BCBA-D
Phone: 206-535-8876