Provider Demographics
NPI:1275948234
Name:SEAGATE PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SEAGATE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-853-8257
Mailing Address - Street 1:2800 E MADISON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4871
Mailing Address - Country:US
Mailing Address - Phone:206-853-8257
Mailing Address - Fax:
Practice Address - Street 1:2800 E MADISON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4871
Practice Address - Country:US
Practice Address - Phone:206-853-8257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000182103TA0400X
WAPY00002708103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty