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3920 15th Ave Ne Uw Mailstop 351635 Seattle WA 98195-1635 | |
| (206) 543-6511 | |
| (206) 616-8367 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3920 15th Ave Ne, Seattle, Washington |
| Authorized Official Name and Position | Corey N Fagan (CLINIC DIRECTOR) |
| Authorized Official Contact | 2065436511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1959 Ne Pacific St Uw Mailstop 351635 Seattle WA 98195-0001 Ph: (205) 543-6511 | 3920 15th Ave Ne Uw Mailstop 351635 Seattle WA 98195-1635 Ph: (206) 543-6511 |
| NPI Number | 1861824211 |
|---|---|
| Provider Enumeration Date | 08/07/2013 |
| Last Update Date | 08/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861824211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | H-128 (Washington) | Primary |
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