Provider Demographics
NPI:1679193346
Name:BE WELL SEATTLE
Entity Type:Organization
Organization Name:BE WELL SEATTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUKUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-578-1427
Mailing Address - Street 1:PO BOX 17866
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98127-1864
Mailing Address - Country:US
Mailing Address - Phone:206-717-4594
Mailing Address - Fax:
Practice Address - Street 1:631 STRANDER BLVD STE G
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2963
Practice Address - Country:US
Practice Address - Phone:206-717-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)