Healthcare Provider Details

I. General information

NPI: 1073090858
Provider Name (Legal Business Name): CONSEJO COUNSELING AND REFERRAL SERVICE - LAKE CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 NE 125TH ST SUITE 145
SEATTLE WA
98125-4373
US

IV. Provider business mailing address

3808 S ANGELINE ST
SEATTLE WA
98118-1712
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4880
  • Fax: 206-367-3199
Mailing address:
  • Phone: 206-461-4880
  • Fax: 206-461-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWA

VIII. Authorized Official

Name: MARIO PAREDES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-461-4880