Provider Demographics
NPI:1235575861
Name:PROFESSIONAL RECREATION ORGANIZATION, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL RECREATION ORGANIZATION, INC.
Other - Org Name:PRO SPORTS CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-869-4746
Mailing Address - Street 1:4455 148TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3120
Mailing Address - Country:US
Mailing Address - Phone:425-869-4746
Mailing Address - Fax:425-869-5285
Practice Address - Street 1:4455 148TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3120
Practice Address - Country:US
Practice Address - Phone:425-869-4746
Practice Address - Fax:425-869-5285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600541508101YM0800X, 103T00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty