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General NPI Number Information
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NPI Number | 1538810718
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Entity Type | Organization
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Legal Business Name | DBT EASTSIDE
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 1400 112TH AVE SE STE 202
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City | BELLEVUE
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State | WA
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Zip | 98004-6901
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Country | US
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Telephone | 425-615-0605
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 112TH AVE SE STE 202
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City | BELLEVUE
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State | WA
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Zip | 98004-6901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DANIEL HANSON
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Credential |
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Telephone | 206-446-9046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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