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General NPI Number Information
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NPI Number | 1801165972
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Entity Type | Organization
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Legal Business Name | OPAL CLINIC FOR EATING DISORDERS
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1100 NE 45TH ST STE 600
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City | SEATTLE
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State | WA
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Zip | 98105-4696
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Country | US
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Telephone | 206-673-7105
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 NE 45TH ST STE 600
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City | SEATTLE
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State | WA
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Zip | 98105-4696
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Country | US
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Telephone | 206-926-9087
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Fax |
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Authorized Official
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Title or Position | NUTRITION DIRECTOR
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Name | JULIE CHURCH
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Credential | RD, CD
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Telephone | 206-926-9087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 271
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License Number State | WA
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