| Square One | |
|
21300 68th Ave W Ste 105 Lynnwood WA 98036-7310 | |
| (425) 412-3155 | |
| (425) 249-3522 |
| Full Name | Square One |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 21300 68th Ave W Ste 105, Lynnwood, Washington |
| Authorized Official Name and Position | Jessica Whitehead (CEO) |
| Authorized Official Contact | 4254123155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Square One 21300 68th Ave W Ste 105 Lynnwood WA 98036-7310 Ph: (425) 412-3155 | Square One 21300 68th Ave W Ste 105 Lynnwood WA 98036-7310 Ph: (425) 412-3155 |
| NPI Number | 1730654849 |
|---|---|
| Provider Enumeration Date | 10/04/2018 |
| Last Update Date | 11/04/2021 |
| Certification Date | 11/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730654849 | NPI | - | NPPES |
| 2125346 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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