Provider Demographics
NPI:1700595949
Name:SEEDED SOMATICS LLC
Entity Type:Organization
Organization Name:SEEDED SOMATICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OBI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CDACI, LPC-ASSOC
Authorized Official - Phone:971-940-3634
Mailing Address - Street 1:5263 NE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5263 NE 32ND PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6915
Practice Address - Country:US
Practice Address - Phone:971-940-3634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1538309364Medicaid