Healthcare Provider Details

I. General information

NPI: 1083771851
Provider Name (Legal Business Name): CONSEJO COUNSELING AND REFERRAL SERVICE - SOUTH PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 14TH AVE S
SEATTLE WA
98108-4806
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: 206-762-0489
Mailing address:
  • Phone: 206-461-4880
  • Fax: 206-461-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number600287044
License Number StateWA
# 2
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