Provider Demographics
NPI:1326561663
Name:COMMUNITY PSYCHIATRIC CLINIC INC
Entity Type:Organization
Organization Name:COMMUNITY PSYCHIATRIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SYMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-545-2387
Mailing Address - Street 1:11000 LAKE CITY WAY NE STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6748
Mailing Address - Country:US
Mailing Address - Phone:206-747-7191
Mailing Address - Fax:
Practice Address - Street 1:11000 LAKE CITY WAY NE STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6748
Practice Address - Country:US
Practice Address - Phone:206-747-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1014968Medicaid