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General NPI Number Information
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NPI Number | 1891152831
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Entity Type | Organization
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Legal Business Name | EATING RECOVERY CENTER OF WASHINGTON
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 1601 114TH AVE SE SUITE 180
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City | BELLEVUE
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State | WA
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Zip | 98004-6950
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Country | US
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Telephone | 425-451-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 114TH AVE SE APT 3
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City | BELLEVUE
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State | WA
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Zip | 98004-6950
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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 | PRIMARY THERAPIST
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Name | MS. JESSIE MCGRATH
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Credential | LMHC
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Telephone | 206-446-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | LH 60546224
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License Number State | WA
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