Provider Demographics
NPI:1801165972
Name:OPAL CLINIC FOR EATING DISORDERS
Entity type:Organization
Organization Name:OPAL CLINIC FOR EATING DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CD
Authorized Official - Phone:206-926-9087
Mailing Address - Street 1:1100 NE 45TH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4696
Mailing Address - Country:US
Mailing Address - Phone:206-926-9087
Mailing Address - Fax:
Practice Address - Street 1:1100 NE 45TH ST STE 600
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4696
Practice Address - Country:US
Practice Address - Phone:206-673-7105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA271251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health