| Full Name | Desc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 515 3rd Ave, Seattle, Washington |
| Authorized Official Name and Position | Daniel Malone (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2064641570 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Desc 515 3rd Ave Seattle WA 98104-2304 Ph: (206) 464-1570 | Desc 515 3rd Ave Seattle WA 98104 Ph: (206) 464-1570 |
| NPI Number | 1235254616 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 05/31/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235254616 | NPI | - | NPPES |
| 1993690 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 090 (Washington) | Primary |
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