MEDICARE: TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, 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)

General Provider Information

NPI Number	:	1982135554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC.

Provider Business Mailing Address
First Line	:	1080 MARINA VILLAGE PARKWAY
Second Line	:	SUITE 100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-1078
Country	:	US
Telephone Number	:	510-337-7950
Fax Number	:	510-337-7969

Provider Business Practice Location Address
First Line	:	601 W FRANKLIN ST
Second Line	:	SUITE B
City	:	SHELTON
State	:	WA
Zip	:	98584-3518
Country	:	US
Telephone Number	:	360-462-3016
Fax Number	:	360-462-3017

Authorized Official
Title or Position	:	SVP, CFO
Name	:	LESLIE DAVIS
Credential	:
Telephone Number	:	510-337-7950

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	01/11/2022

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