1982789764 NPI number — DR. CHERYL RUTH AZLIN PSYD

Table of content: DR. CHERYL RUTH AZLIN PSYD (NPI 1982789764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982789764 NPI number — DR. CHERYL RUTH AZLIN PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZLIN
Provider First Name:
CHERYL
Provider Middle Name:
RUTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982789764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26828 MAPLE VALLEY BLACK DIAMOND RD SE # 117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98038-8309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-843-0513
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22916 SE 241ST PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98038-5248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-843-0513
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  00003861 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W05251 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: VENDOR # A014624 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043239341 . This is a "HEALTHCARE VALUE MGMT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04323934101 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: ITSNHMCK00 . This is a "BEHAVIORAL HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008964 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: W05251 . This is a "BLUE CARE 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 244786 . This is a "MAGELLAN BEHAVIORAL HLTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 760564 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: W05251 . This is a "PERSONAL HELP CONNECTION" identifier . This identifiers is of the category "OTHER".
  • Identifier: W05251 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04323934101 . This is a "PACIFICARE BEHAVIOR HLTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: W05251 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0432393410002 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1017950 . This is a "BEACON HEALTH STRATEGIES" identifier . This identifiers is of the category "OTHER".




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