1205117157 NPI number — TARLETON DIMAGGIO BROWN AA, AAC

Table of content: TARLETON DIMAGGIO BROWN AA, AAC (NPI 1205117157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205117157 NPI number — TARLETON DIMAGGIO BROWN AA, AAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
TARLETON
Provider Middle Name:
DIMAGGIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AA, AAC
Provider Gender Code:
M

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:
1205117157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 E OLIVE ST
Provider Second Line Business Mailing Address:
SOUND MENTAL HEALTH
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-302-2200
Provider Business Mailing Address Fax Number:
206-302-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 29TH ST SE
Provider Second Line Business Practice Location Address:
CHARTLEY HOUSE
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-7541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-302-2200
Provider Business Practice Location Address Fax Number:
206-302-2210
Provider Enumeration Date:
09/06/2011

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: 101Y00000X , with the licence number:  CG60197008 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CG60197008 , 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)





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