Provider Demographics
NPI:1346616224
Name:ODYSSEUS INTERNATIONAL LLC
Entity Type:Organization
Organization Name:ODYSSEUS INTERNATIONAL LLC
Other - Org Name:PACIFIC NORTHWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-226-8434
Mailing Address - Street 1:2607 WESTERN AVE
Mailing Address - Street 2:APT 153
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 1101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:253-237-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60476809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty