Provider Demographics
NPI:1083882260
Name:EVIDENCE BASED TREATMENT CENTERS OF SEATTLE
Entity Type:Organization
Organization Name:EVIDENCE BASED TREATMENT CENTERS OF SEATTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST & POST-DOC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-374-0109
Mailing Address - Street 1:1218 3RD AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3081
Mailing Address - Country:US
Mailing Address - Phone:206-374-0109
Mailing Address - Fax:206-374-0108
Practice Address - Street 1:1218 3RD AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3097
Practice Address - Country:US
Practice Address - Phone:206-374-0109
Practice Address - Fax:206-374-0108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVIDENCE BASED TREATMENT CENTERS OF SEATTLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY3666251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health