Healthcare Provider Details

I. General information

NPI: 1053498220
Provider Name (Legal Business Name): CENTER FOR HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17018 15TH AVE NE
SHORELINE WA
98155-5126
US

IV. Provider business mailing address

17018 15TH AVE NE
SHORELINE WA
98155-5126
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-7282
  • Fax: 206-362-7152
Mailing address:
  • Phone: 206-362-7282
  • Fax: 206-362-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number17015900
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number154
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number17015900
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number17015900
License Number StateWA

VIII. Authorized Official

Name: BERATTA GOMILLION
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-362-7282