Provider Demographics
NPI:1205258720
Name:SEATTLE PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:SEATTLE PSYCHOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LI
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-909-5574
Mailing Address - Street 1:1307 N 45TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6741
Mailing Address - Country:US
Mailing Address - Phone:206-420-4701
Mailing Address - Fax:206-420-4841
Practice Address - Street 1:1307 N 45TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6741
Practice Address - Country:US
Practice Address - Phone:206-420-4701
Practice Address - Fax:206-420-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty