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General NPI Number Information
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NPI Number | 1013188994
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST TREATMENT SERVICES
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 40 LAKE BELLEVUE DR SUITE 100
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City | BELLEVUE
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State | WA
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Zip | 98005-2479
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Country | US
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Telephone | 425-641-1999
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Fax | 425-641-4069
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Provider Business Mailing Address
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Address Line | 40 LAKE BELLEVUE DR SUITE 100
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City | BELLEVUE
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State | WA
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Zip | 98005-2479
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Country | US
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Telephone | 425-641-1999
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Fax | 425-641-4069
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Authorized Official
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Title or Position | OWNER
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Name | MR. GLEN P. MERRIWETHER
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Credential | MA, LMHC, CDP
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Telephone | 425-641-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | WA
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