Provider Demographics
NPI:1073090858
Name:CONSEJO COUNSELING AND REFERRAL SERVICE - LAKE CITY
Entity Type:Organization
Organization Name:CONSEJO COUNSELING AND REFERRAL SERVICE - LAKE CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-461-4880
Mailing Address - Street 1:3808 S ANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1712
Mailing Address - Country:US
Mailing Address - Phone:206-461-4880
Mailing Address - Fax:206-461-6989
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 145
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-461-4880
Practice Address - Fax:206-367-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200187OtherDBHR SITE LICENSE ID