=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124546973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUND MIND NORTHWEST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2017
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2027 196TH ST SW STE A205
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-7073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-553-1548
-----------------------------------------------------
Fax | 206-899-1951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6702 N 89TH LOOP
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-6753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-785-7566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN SEATON WHITE
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 360-553-1548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | LW60754230
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------