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General NPI Number Information
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NPI Number | 1073433405
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Entity Type | Organization
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Legal Business Name | TELEHEALTH MH LLC
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 4055 LAKE WASHINGTON BLVD NE STE 100 OFFICE 2
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City | KIRKLAND
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State | WA
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Zip | 98033-7871
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Country | US
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Telephone | 425-645-7443
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 E WHITESTONE BLVD STE 1304D
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City | CEDAR PARK
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State | TX
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Zip | 78613-9072
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Country | US
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Telephone | 425-645-7443
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JACK BRENNAN
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Credential |
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Telephone | 425-645-7443
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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 |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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