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1307 N 45th St Suite 200 Seattle WA 98103-6741 | |
| (206) 420-4701 | |
| (206) 420-4841 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1307 N 45th St, Seattle, Washington |
| Authorized Official Name and Position | Li K Ravicz (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2069095574 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1307 N 45th St Suite 200 Seattle WA 98103-6741 Ph: (206) 420-4701 | 1307 N 45th St Suite 200 Seattle WA 98103-6741 Ph: (206) 420-4701 |
| NPI Number | 1205258720 |
|---|---|
| Provider Enumeration Date | 01/17/2014 |
| Last Update Date | 01/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205258720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | PY00002395 (Washington) | Primary |
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