Provider Demographics
NPI:1013188994
Name:PACIFIC NORTHWEST TREATMENT SERVICES
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MERRIWETHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, CDP
Authorized Official - Phone:425-641-1999
Mailing Address - Street 1:40 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2479
Mailing Address - Country:US
Mailing Address - Phone:425-641-1999
Mailing Address - Fax:425-641-4069
Practice Address - Street 1:40 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2479
Practice Address - Country:US
Practice Address - Phone:425-641-1999
Practice Address - Fax:425-641-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health