MEDICARE: SEATTLE INSTITUTE FOR FAMILY THERAPY

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)

General Provider Information

NPI Number	:	1750863668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEATTLE INSTITUTE FOR FAMILY THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 31843
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-1843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N 36TH ST STE 415
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8699
Country	:	US
Telephone Number	:	267-997-8744
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANTHONY G PENNANT JR.
Credential	:	LMFT
Telephone Number	:	267-997-8744

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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