Provider Demographics
NPI:1861824211
Name:UNIVERSITY OF WASHINGTON
Entity Type:Organization
Organization Name:UNIVERSITY OF WASHINGTON
Other - Org Name:UW PSYCHOLOGICAL SERVICES & TRAINING CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-543-6511
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:UW MAILSTOP 351635
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:205-543-6511
Mailing Address - Fax:206-616-8367
Practice Address - Street 1:3920 15TH AVE NE
Practice Address - Street 2:UW MAILSTOP 351635
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-1635
Practice Address - Country:US
Practice Address - Phone:206-543-6511
Practice Address - Fax:206-616-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-128261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)