Healthcare Provider Details

I. General information

NPI: 1144436312
Provider Name (Legal Business Name): EVIDENCE BASED TREATMENT CENTERS OF SEATTLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 3RD AVE STE 500
SEATTLE WA
98101-3067
US

IV. Provider business mailing address

1218 3RD AVE STE 500
SEATTLE WA
98101-3067
US

V. Phone/Fax

Practice location:
  • Phone: 206-374-0109
  • Fax: 206-374-0108
Mailing address:
  • Phone: 206-374-0109
  • Fax: 206-374-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY P. DUBOSE
Title or Position: CEO & PRESIDENT
Credential: PSY.D.
Phone: 206-374-0109