Provider Demographics
NPI:1487841953
Name:PACIFIC MEDICAL EVALUATIONS AND TREATMENT SERVICES, PLLC
Entity Type:Organization
Organization Name:PACIFIC MEDICAL EVALUATIONS AND TREATMENT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINSS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-802-2861
Mailing Address - Street 1:10634 E RIVERSIDE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3758
Mailing Address - Country:US
Mailing Address - Phone:425-806-5021
Mailing Address - Fax:
Practice Address - Street 1:10634 E RIVERSIDE DR STE 130
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3758
Practice Address - Country:US
Practice Address - Phone:425-806-5021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGROUP PRACTICE - MAN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX ID