Provider Demographics
NPI:1053855833
Name:BLUETREAD THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:BLUETREAD THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:206-508-4576
Mailing Address - Street 1:2366 EASTLAKE AVE E STE 215
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-6501
Mailing Address - Country:US
Mailing Address - Phone:206-508-4576
Mailing Address - Fax:206-512-1654
Practice Address - Street 1:2366 EASTLAKE AVE E STE 215
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-6501
Practice Address - Country:US
Practice Address - Phone:206-508-4576
Practice Address - Fax:206-512-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60717794251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health