Healthcare Provider Details

I. General information

NPI: 1447551221
Provider Name (Legal Business Name): ATLANTIC STREET CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S ATLANTIC ST
SEATTLE WA
98144-3615
US

IV. Provider business mailing address

2103 S ATLANTIC ST
SEATTLE WA
98144-3615
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-2050
  • Fax: 206-329-2171
Mailing address:
  • Phone: 206-329-2050
  • Fax: 206-329-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number147
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number147
License Number StateWA

VIII. Authorized Official

Name: DAN YULY
Title or Position: DIRECTOR OF OPERATIONS AND FINANCE
Credential:
Phone: 206-329-2050