Provider Demographics
NPI:1780303685
Name:PACIFIC ROOTS MENTAL HEALTH
Entity type:Organization
Organization Name:PACIFIC ROOTS MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:COLEEN
Authorized Official - Last Name:MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:425-954-6796
Mailing Address - Street 1:19125 N CREEK PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8000
Mailing Address - Country:US
Mailing Address - Phone:425-954-6796
Mailing Address - Fax:
Practice Address - Street 1:19125 N CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8000
Practice Address - Country:US
Practice Address - Phone:425-954-6796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604923091OtherSECRETARY OF STATE ISSUED UBI