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10740 Meridian Ave N Ste 107 Seattle WA 98133 | |
| (206) 432-9020 | |
| (206) 432-9437 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 10740 Meridian Ave N Ste 107, Seattle, Washington |
| Authorized Official Name and Position | James Edward Lolley (CO-OWNER) |
| Authorized Official Contact | 2064329020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10740 Meridian Ave N Ste 107 Seattle WA 98133-9010 Ph: (206) 432-9020 | 10740 Meridian Ave N Ste 107 Seattle WA 98133 Ph: (206) 432-9020 |
| NPI Number | 1639685241 |
|---|---|
| Provider Enumeration Date | 12/19/2017 |
| Last Update Date | 09/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639685241 | NPI | - | NPPES |
| 1427474618 | Other | INDIVIDUAL PROVIDER NPI | |
| 1962621284 | Other | INDIVIDUAL PROVIDER NPI | |
| 1639685241 | Other | GROUP NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY60345764 (Washington) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Washington) | Primary |
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