1043828643 NPI number — TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC.

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 1043828643 NPI number — TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TELECARE MENTAL HEALTH SERVICES OF WASHINGTON, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1043828643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1080 MARINA VILLAGE PKWY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94501-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-337-7950
Provider Business Mailing Address Fax Number:
510-337-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3436 MARY ELDER RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98506-5050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-528-2590
Provider Business Practice Location Address Fax Number:
360-528-2595
Provider Enumeration Date:
07/20/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CFO
Authorized Official Telephone Number:
510-337-7950

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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