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General NPI Number Information
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NPI Number | 1558803908
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Entity Type | Organization
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Legal Business Name | SHAMATHA PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 5425 RAINIER AVE S STE A
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City | SEATTLE
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State | WA
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Zip | 98118-2455
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Country | US
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Telephone | 650-336-5384
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Fax | 844-787-9886
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Provider Business Mailing Address
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Address Line | 2806 E DENNY WAY
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City | SEATTLE
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State | WA
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Zip | 98122-3126
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Country | US
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Telephone | 206-769-5685
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Fax | 844-787-9886
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BART THOMAS OZRETICH
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Credential | MSW, LICSW
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Telephone | 650-336-5384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00009370
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License Number State | WA
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