Provider Demographics
NPI:1346497807
Name:THERAPEUTIC HEALTH SERVICES
Entity Type:Organization
Organization Name:THERAPEUTIC HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-323-0930
Mailing Address - Street 1:5802 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2706
Mailing Address - Country:US
Mailing Address - Phone:206-723-1980
Mailing Address - Fax:206-721-3930
Practice Address - Street 1:1116 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2831
Practice Address - Country:US
Practice Address - Phone:206-323-0930
Practice Address - Fax:206-323-3634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPEUTIC HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA032261QM0850X
WA17015800261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1990001Medicaid
WA1994086Medicaid
WA1991116Medicaid
WA1993542Medicaid
WA1994664Medicaid
WA1993658Medicaid
WA1995539Medicaid