Healthcare Provider Details

I. General information

NPI: 1447947866
Provider Name (Legal Business Name): POSITIVE DYNAMICS CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH AVE STE 101-800
SEATTLE WA
98104-3176
US

IV. Provider business mailing address

800 5TH AVE STE 101-800
SEATTLE WA
98104-3176
US

V. Phone/Fax

Practice location:
  • Phone: 888-887-6396
  • Fax: 833-799-8555
Mailing address:
  • Phone: 888-887-6396
  • Fax: 833-799-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MANUEL ANTONIO PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 206-960-0373