| |
24823 Pacific Hwy S Ste 103 Kent WA 98032-5478 | |
(253) 681-0010 | |
(253) 681-0014 |
Full Name | |
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Speciality | Clinic/center - Adult Mental Health |
Location | 24823 Pacific Hwy S Ste 103, Kent, Washington |
Authorized Official Name and Position | Sean Potter (BILLING MANAGER) |
Authorized Official Contact | 2063230930 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5802 Rainier Ave S Seattle WA 98118-2706 Ph: (206) 723-1980 | 24823 Pacific Hwy S Ste 103 Kent WA 98032-5478 Ph: (253) 681-0010 |
NPI Number | 1619254729 |
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Provider Enumeration Date | 11/03/2011 |
Last Update Date | 10/04/2023 |
Certification Date | 10/04/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619254729 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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