| Fidalgo Behavioral Health | |
|
601 O Ave Anacortes WA 98221-1753 | |
| (360) 755-3474 | |
| (877) 241-4344 |
| Full Name | Fidalgo Behavioral Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 601 O Ave, Anacortes, Washington |
| Authorized Official Name and Position | Nathanael Ward Cardon (PROVIDER, SOLE MEMBER) |
| Authorized Official Contact | 3607553474 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fidalgo Behavioral Health Po Box 1318 Anacortes WA 98221-6318 Ph: () - | Fidalgo Behavioral Health 601 O Ave Anacortes WA 98221-1753 Ph: (360) 755-3474 |
| NPI Number | 1841704814 |
|---|---|
| Provider Enumeration Date | 11/28/2017 |
| Last Update Date | 12/29/2023 |
| Certification Date | 12/29/2023 |
| Medicare PECOS PAC ID | 5193151033 |
|---|---|
| Medicare Enrollment ID | O20200212001438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841704814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | OP60248624 (Washington) | Primary |
| Provider Name | Nathanael Cardon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861606360 PECOS PAC ID: 7810164399 Enrollment ID: I20120124000800 |
| Provider Name | James Frederick Marshall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578813044 PECOS PAC ID: 9638513260 Enrollment ID: I20240221004439 |
| Provider Name | David Maurice White |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1033626536 PECOS PAC ID: 8325483894 Enrollment ID: I20240224000192 |
| Provider Name | Kelly Dunn Moloney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427207935 PECOS PAC ID: 2961842604 Enrollment ID: I20240429003095 |
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