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General NPI Number Information
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NPI Number | 1700530854
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Entity Type | Organization
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Legal Business Name | ERA OF RESTORATION MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 4630 200TH ST SW STE C
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City | LYNNWOOD
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State | WA
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Zip | 98036-6608
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Country | US
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Telephone | 425-670-0280
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Fax | 425-670-0278
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Provider Business Mailing Address
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Address Line | 4630 200TH ST SW STE C
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City | LYNNWOOD
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State | WA
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Zip | 98036-6608
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Country | US
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Telephone | 425-670-0280
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Fax | 425-670-0278
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | HEATHER O'NEAL
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Credential |
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Telephone | 425-670-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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