Healthcare Provider Details

I. General information

NPI: 1598201568
Provider Name (Legal Business Name): THERAPEUTIC HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SPRING ST
SEATTLE WA
98104
US

IV. Provider business mailing address

5802 RAINIER AVE S
SEATTLE WA
98118-2706
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0930
  • Fax:
Mailing address:
  • Phone: 206-723-1980
  • Fax: 206-721-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number601-141-702
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: SEAN POTTER
Title or Position: BILLING MANAGER
Credential:
Phone: 206-323-0930