Provider Demographics
NPI:1780870675
Name:UNIVERSITY OF WASHINGTON, BEHAVIORAL RESEARCY & THERAPY CLINICS
Entity type:Organization
Organization Name:UNIVERSITY OF WASHINGTON, BEHAVIORAL RESEARCY & THERAPY CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-543-2630
Mailing Address - Street 1:1535 NE 40TH STREET
Mailing Address - Street 2:GUTHRIE ANNEX 4, RM 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-1525
Mailing Address - Country:US
Mailing Address - Phone:206-543-2630
Mailing Address - Fax:206-616-1513
Practice Address - Street 1:1535 NE 40TH STREET
Practice Address - Street 2:GUTHRIE ANNEX 4, RM 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-2630
Practice Address - Fax:206-616-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00055788103T00000X, 103TA0400X, 103TC0700X, 103TP2701X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty