Provider Demographics
NPI:1124546973
Name:SOUND MIND NORTHWEST
Entity Type:Organization
Organization Name:SOUND MIND NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SEATON
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-553-1548
Mailing Address - Street 1:11526 PHINNEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8623
Mailing Address - Country:US
Mailing Address - Phone:425-785-7566
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 54TH ST STE 480
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3562
Practice Address - Country:US
Practice Address - Phone:360-553-1548
Practice Address - Fax:360-553-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60754230261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720337579Medicaid