=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164972600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENSUM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2016
-----------------------------------------------------
Last Update Date | 10/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 WESTLAKE AVE N SUITE 901
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98109-3543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-354-1754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1244 20TH AVE E
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112-3531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-354-1754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LISENCED MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | MS. TIFFANY J DORRELL DAHL
-----------------------------------------------------
Credential | M.A., LMHC
-----------------------------------------------------
Telephone | 206-354-1754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LH00009300
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | LH00009300
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | LH00009300
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------