Healthcare Provider Details

I. General information

NPI: 1568652220
Provider Name (Legal Business Name): SOUND MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E OLIVE ST
SEATTLE WA
98122-2735
US

IV. Provider business mailing address

1600 E OLIVE ST
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2200
  • Fax: 206-302-2210
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PAUL M EISENHAUER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO, MBA, MA
Phone: 206-302-2200