Provider Demographics
NPI:1083046270
Name:UNITED BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:UNITED BEHAVIORAL HEALTH
Other - Org Name:OPTUM WASHINGTON HEALTH HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOLEZAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:253-292-4189
Mailing Address - Street 1:3315 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1605
Mailing Address - Country:US
Mailing Address - Phone:253-292-4189
Mailing Address - Fax:253-292-4219
Practice Address - Street 1:3315 S 23RD ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1605
Practice Address - Country:US
Practice Address - Phone:253-292-4189
Practice Address - Fax:253-292-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000085OtherWASHINGTON STATE HEALTH CARE AUTHORITY
WA200008501OtherWASHINGTON STATE HEALTH CARE AUTHORITY