Provider Demographics
NPI:1396017703
Name:BELLEVUE COMMUNITY SERVICES
Entity type:Organization
Organization Name:BELLEVUE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:425-454-0616
Mailing Address - Street 1:1160 140TH AVE NE
Mailing Address - Street 2:STE F
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2978
Mailing Address - Country:US
Mailing Address - Phone:425-454-0616
Mailing Address - Fax:425-637-1289
Practice Address - Street 1:1160 140TH AVE NE
Practice Address - Street 2:STE F
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2978
Practice Address - Country:US
Practice Address - Phone:425-454-0616
Practice Address - Fax:425-637-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602228527251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health