DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1629120159

NPI Code Detail

MEDICARE: COMMUNITY PSYCHIATRIC CLINIC INC

MEDICARE: COMMUNITY PSYCHIATRIC CLINIC INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	035	WA
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	17087600	WA
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	17087500	WA
4	251S00000X	Community/Behavioral Health Agency	117700	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629120159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PSYCHIATRIC CLINIC INC

Provider Business Mailing Address
First Line	:	11000 LAKE CITY WAY NE
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98125-6748
Country	:	US
Telephone Number	:	206-461-3614
Fax Number	:	206-634-0094

Provider Business Practice Location Address
First Line	:	11000 LAKE CITY WAY NE
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98125-6748
Country	:	US
Telephone Number	:	206-461-3614
Fax Number	:	206-634-0094

Authorized Official
Title or Position	:	ADMIN SUPERVISOR
Name	:	MISS KELCEY SYMONS
Credential	:
Telephone Number	:	206-545-2387

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	09/26/2018

Similar Medicare Providers

1164393625 — GABRIELLE GELFAND
Practice Location Address:

11000 LAKE CITY WAY NE
SEATTLE, WA
98125-6748

Practice Phone: 206-901-2000
Practice Fax: 206-901-2010

1699633313 — HALEY COLLEEN RAYBURN
Practice Location Address:

11000 LAKE CITY WAY NE
SEATTLE, WA
98125-6748

Practice Phone: 206-901-2000
Practice Fax:

1386471241 — BRYAN ROBERT HALL
Practice Location Address:

11000 LAKE CITY WAY NE
SEATTLE, WA
98125-6748

Practice Phone: 206-901-2000
Practice Fax:

1730309147 — DR. BELINDA J GUSTAFSON MD
Practice Location Address:

11000 LAKE CITY WAY NE , SUITE 200
SEATTLE, WA
98125-6748

Practice Phone: 206-461-3614
Practice Fax: 206-634-0094

1740619360 — CHANTAY BROWN MSCMHC
Practice Location Address:

11000 LAKE CITY WAY NE
SEATTLE, WA
98125-6748

Practice Phone: 206-461-3614
Practice Fax:

1265859714 — DANIELLE FUNK MA, BCBA, LBA
Practice Location Address:

11000 LAKE CITY WAY NE
SEATTLE, WA
98125-6748

Practice Phone: 206-901-2000
Practice Fax:

Directions to “COMMUNITY PSYCHIATRIC CLINIC INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.