Healthcare Provider Details

I. General information

NPI: 1326561663
Provider Name (Legal Business Name): COMMUNITY PSYCHIATRIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 LAKE CITY WAY NE STE 200
SEATTLE WA
98125-6748
US

IV. Provider business mailing address

11000 LAKE CITY WAY NE STE 200
SEATTLE WA
98125-6748
US

V. Phone/Fax

Practice location:
  • Phone: 206-747-7191
  • Fax:
Mailing address:
  • Phone: 206-747-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KELCEY SYMONS
Title or Position: ADMIN SERVICES MANAGER
Credential:
Phone: 206-545-2387