Provider Demographics
NPI:1891296455
Name:ALLASSO LLC
Entity Type:Organization
Organization Name:ALLASSO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLENOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-387-4368
Mailing Address - Street 1:3533 SW WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3258
Mailing Address - Country:US
Mailing Address - Phone:510-387-4368
Mailing Address - Fax:
Practice Address - Street 1:2201 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2080
Practice Address - Country:US
Practice Address - Phone:510-387-4368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALMFT00002564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty