Provider Demographics
NPI:1659411874
Name:WINCORP WIDEWORLD
Entity Type:Organization
Organization Name:WINCORP WIDEWORLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMHC
Authorized Official - Phone:206-772-2200
Mailing Address - Street 1:126 SW 148TH ST
Mailing Address - Street 2:C100 STE 203
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1984
Mailing Address - Country:US
Mailing Address - Phone:206-772-2200
Mailing Address - Fax:425-361-1643
Practice Address - Street 1:126 SW 148TH ST
Practice Address - Street 2:C100 STE 203
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1984
Practice Address - Country:US
Practice Address - Phone:206-772-2200
Practice Address - Fax:425-361-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26271014OtherBCBS OF KC IDENTIFIER
WAAN1027OtherRIDER NUMBER FOR REGENCE