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4630 200th St Sw Ste C Lynnwood WA 98036-6608 | |
| (425) 670-0280 | |
| (425) 670-0278 |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 4630 200th St Sw Ste C, Lynnwood, Washington |
| Authorized Official Name and Position | Heather O'neal (ADMINISTRATIVE MANAGER) |
| Authorized Official Contact | 4256700280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4630 200th St Sw Ste C Lynnwood WA 98036-6608 Ph: (425) 670-0280 | 4630 200th St Sw Ste C Lynnwood WA 98036-6608 Ph: (425) 670-0280 |
| NPI Number | 1700530854 |
|---|---|
| Provider Enumeration Date | 02/08/2022 |
| Last Update Date | 12/23/2022 |
| Certification Date | 12/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700530854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
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