Provider Demographics
NPI:1619563186
Name:DIVINE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:DIVINE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANKWOOKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-290-3172
Mailing Address - Street 1:720 N 10TH ST STE A399
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5683
Mailing Address - Country:US
Mailing Address - Phone:206-290-7385
Mailing Address - Fax:
Practice Address - Street 1:720 N 10TH ST STE A399
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5683
Practice Address - Country:US
Practice Address - Phone:206-290-7385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health