Healthcare Provider Details

I. General information

NPI: 1376089151
Provider Name (Legal Business Name): CASCADES WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 N 34TH ST STE 206
SEATTLE WA
98103-9089
US

IV. Provider business mailing address

1914 N 34TH ST STE 206
SEATTLE WA
98103-9089
US

V. Phone/Fax

Practice location:
  • Phone: 847-687-9313
  • Fax:
Mailing address:
  • Phone: 847-687-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60582444
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY60560787
License Number StateWA

VIII. Authorized Official

Name: DR. THOMAS FARMER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 847-687-9313