Provider Demographics
NPI:1679860860
Name:COMMUNITY PSYCHIATRIC CLINIC INC
Entity Type:Organization
Organization Name:COMMUNITY PSYCHIATRIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:UNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-545-2317
Mailing Address - Street 1:10501 MERIDIAN AVE N
Mailing Address - Street 2:SUITE D
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9509
Mailing Address - Country:US
Mailing Address - Phone:206-461-4544
Mailing Address - Fax:
Practice Address - Street 1:10501 MERIDIAN AVE N
Practice Address - Street 2:SUITE D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9509
Practice Address - Country:US
Practice Address - Phone:206-461-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30008035261QM0850X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA391880OtherUNIVERSITY OF WASHINGTON