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564 Ne Ravenna Blvd Seattle WA 98115-6460 | |
| (206) 527-2266 | |
| (206) 527-1009 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 564 Ne Ravenna Blvd, Seattle, Washington |
| Authorized Official Name and Position | James Howard Ramsey (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 2065272266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
564 Ne Ravenna Blvd Seattle WA 98115-6460 Ph: (206) 527-2266 | 564 Ne Ravenna Blvd Seattle WA 98115-6460 Ph: (206) 527-2266 |
| NPI Number | 1174628614 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 03/05/2024 |
| Certification Date | 03/05/2024 |
| Medicare PECOS PAC ID | 8325031040 |
|---|---|
| Medicare Enrollment ID | O20040407000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174628614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 501158343 (Washington) | Primary |
| Provider Name | Daniel F Kujawinski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881980274 PECOS PAC ID: 6103121256 Enrollment ID: I20160226001280 |
| Provider Name | Carl Hilton Vanosdall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710918073 PECOS PAC ID: 1456330604 Enrollment ID: I20220610000735 |
| Provider Name | Nathalia M Worms |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336483502 PECOS PAC ID: 1951777234 Enrollment ID: I20221012002230 |
| Provider Name | Kristen Moss |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457731580 PECOS PAC ID: 2860830668 Enrollment ID: I20240328003764 |
| Provider Name | Gary O. Steeves |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447355961 PECOS PAC ID: 7618316225 Enrollment ID: I20240416001405 |
| Provider Name | Mary Kate Stanton-nurse |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1346644481 PECOS PAC ID: 8527409044 Enrollment ID: I20240515002841 |
| Provider Name | John N. Baumann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891000311 PECOS PAC ID: 0345788899 Enrollment ID: I20240814003952 |
| Provider Name | James Howard Ramsey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780922757 PECOS PAC ID: 4082051537 Enrollment ID: I20241105003543 |
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