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General NPI Number Information
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NPI Number | 1932529120
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Entity Type | Organization
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Legal Business Name | PACIFIC BEHAVIORAL HEALTHCARE
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Dates
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Enumeration Date | 04/26/2014
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 2370 130TH AVE NE STE 104
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City | BELLEVUE
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State | WA
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Zip | 98005-1770
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Country | US
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Telephone | 425-628-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 2370 130TH AVE NE STE 104
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City | BELLEVUE
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State | WA
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Zip | 98005-1770
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Country | US
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Telephone | 425-628-2820
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES PHILLIP OLSEN
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Credential | J.D., PH.D., LMHC
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Telephone | 425-628-2820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 60411510
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH 60450953
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License Number State | WA
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