Provider Demographics
NPI:1639685241
Name:BEHAVIORAL HEALTH COLLABORATIVE
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH COLLABORATIVE
Other - Org Name:JAMES LOLLEY
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-432-9020
Mailing Address - Street 1:10740 MERIDIAN AVE N STE 107
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9010
Mailing Address - Country:US
Mailing Address - Phone:206-432-9020
Mailing Address - Fax:206-432-9437
Practice Address - Street 1:10740 MERIDIAN AVE N STE 107
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-432-9020
Practice Address - Fax:206-432-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60345764103TC0700X
WA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427474618OtherINDIVIDUAL PROVIDER NPI
1962621284OtherINDIVIDUAL PROVIDER NPI
1639685241OtherGROUP NPI