1447494455 NPI number — SEASIDE MENTAL HEALTH AND PSYCHIATRIC SERVICES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447494455 NPI number — SEASIDE MENTAL HEALTH AND PSYCHIATRIC SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEASIDE MENTAL HEALTH AND PSYCHIATRIC SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SEASIDE MENTAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1447494455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
772 CAMANO AVE
Provider Second Line Business Mailing Address:
SUITE 201B-B
Provider Business Mailing Address City Name:
LANGLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98260-9288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-903-1371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
828 2ND ST
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
MUKILTEO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98275-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-903-1371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MONTAPERTO
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
425-903-1371

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  AP 30007333 , 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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