Healthcare Provider Details

I. General information

NPI: 1467126607
Provider Name (Legal Business Name): UNDER ONE ROOF PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 25TH AVE NE STE 102W
SEATTLE WA
98105-5667
US

IV. Provider business mailing address

4915 25TH AVE NE STE 102W
SEATTLE WA
98105-5667
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-0134
  • Fax: 206-397-4962
Mailing address:
  • Phone: 206-257-0134
  • Fax: 206-397-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELISSA BADENNA
Title or Position: ADMIN DIRECT
Credential:
Phone: 206-257-0134