Healthcare Provider Details

I. General information

NPI: 1679860860
Provider Name (Legal Business Name): COMMUNITY PSYCHIATRIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 MERIDIAN AVE N SUITE D
SEATTLE WA
98133-9509
US

IV. Provider business mailing address

10501 MERIDIAN AVE N SUITE D
SEATTLE WA
98133-9509
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4544
  • Fax:
Mailing address:
  • Phone: 206-461-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAP30008035
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberAP30008035
License Number StateWA

VIII. Authorized Official

Name: UNICE ABERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 206-545-2317