Healthcare Provider Details

I. General information

NPI: 1720620644
Provider Name (Legal Business Name): BALLARD AVENUE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 BALLARD AVE NW STE 317
SEATTLE WA
98107-4366
US

IV. Provider business mailing address

5306 BALLARD AVE NW STE 317
SEATTLE WA
98107-4366
US

V. Phone/Fax

Practice location:
  • Phone: 206-455-9008
  • Fax: 437-537-5124
Mailing address:
  • Phone: 206-455-9008
  • Fax: 437-537-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARY LANG-FURR
Title or Position: OWNER/PSYCHIATRIST
Credential: MD
Phone: 206-455-9008