Healthcare Provider Details

I. General information

NPI: 1396510970
Provider Name (Legal Business Name): EMERALD CITY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 CIRQUE DR W
UNIVERSITY PLACE WA
98467-2241
US

IV. Provider business mailing address

7350 CIRQUE DR W
UNIVERSITY PLACE WA
98467-2241
US

V. Phone/Fax

Practice location:
  • Phone: 253-433-7993
  • Fax: 253-540-6886
Mailing address:
  • Phone: 253-433-7993
  • Fax: 253-540-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA JOHNSON
Title or Position: OWNER/ADMINISTRATOR
Credential: MANAGING MEMBER
Phone: 503-515-5046