Provider Demographics
NPI:1184013161
Name:KEEP ON DANCING MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:KEEP ON DANCING MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/OFFICE MNGR., AUTH. OFFICIA
Authorized Official - Prefix:
Authorized Official - First Name:DESSETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-740-3600
Mailing Address - Street 1:2722 COLBY AVE
Mailing Address - Street 2:SUITE 328
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3557
Mailing Address - Country:US
Mailing Address - Phone:425-740-3600
Mailing Address - Fax:425-740-3601
Practice Address - Street 1:2722 COLBY AVE STE 328
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-740-3600
Practice Address - Fax:425-740-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00009392101YM0800X, 101YP2500X, 104100000X, 1041C0700X
106H00000X, 363LP0808X
WARN00059378163W00000X
WAAP30007518363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2054124Medicaid
WA2054124Medicaid
WA965749Medicaid
WA2039295Medicaid