Healthcare Provider Details

I. General information

NPI: 1134650427
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF WASHINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 N SOUND DR
SEDRO WOOLLEY WA
98284-7697
US

IV. Provider business mailing address

1080 MARINA VILLAGE PARKWAY SUITE 100
ALAMEDA CA
94501-1078
US

V. Phone/Fax

Practice location:
  • Phone: 360-854-7400
  • Fax: 360-854-7445
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LORENA LOPEZ
Title or Position: PROVIDER RELATIONS SUPERVISOR
Credential:
Phone: 510-337-7950