Provider Demographics
NPI:1962628297
Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Entity Type:Organization
Organization Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-201-3973
Mailing Address - Street 1:4040 S 188TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5070
Mailing Address - Country:US
Mailing Address - Phone:206-816-3253
Mailing Address - Fax:206-838-2680
Practice Address - Street 1:4040 S 188TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-5070
Practice Address - Country:US
Practice Address - Phone:206-816-3253
Practice Address - Fax:206-838-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACERTIFICATE136101YM0800X, 1041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty