Healthcare Provider Details

I. General information

NPI: 1619354792
Provider Name (Legal Business Name): HEALTHY MIND SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 CALIFORNIA AVE SW
SEATTLE WA
98136-1953
US

IV. Provider business mailing address

4742 42ND AVE SW
SEATTLE WA
98116-4553
US

V. Phone/Fax

Practice location:
  • Phone: 206-935-6228
  • Fax: 206-932-4856
Mailing address:
  • Phone: 206-200-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberAP60449766
License Number StateWA

VIII. Authorized Official

Name: JEANETTE MARIE ELLISON
Title or Position: OWNER
Credential: ARNP
Phone: 206-498-8752