MEDICARE: LISA MARIE BACH MHP, BA, CAAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CG 60131663	WA

General Provider Information

NPI Number	:	1528129392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE BACH MHP, BA, CAAR

Provider Business Mailing Address
First Line	:	1600 E OLIVE ST
Second Line	:	SEATTLE MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98122-2735
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	4240 AUBURN WAY N
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-1311
Country	:	US
Telephone Number	:	253-876-8908
Fax Number	:	253-876-8910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	01/13/2017

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