Provider Demographics
NPI:1194862425
Name:ELLIOTT BAY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ELLIOTT BAY BEHAVIORAL HEALTH
Other - Org Name:EBBH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-860-0860
Mailing Address - Street 1:1001 BROADWAY
Mailing Address - Street 2:#313
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4397
Mailing Address - Country:US
Mailing Address - Phone:206-860-0860
Mailing Address - Fax:206-860-2829
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:#313
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4397
Practice Address - Country:US
Practice Address - Phone:206-860-0860
Practice Address - Fax:206-860-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty