1265858534 NPI number — CENTER FOR SYSTEMATIC THERAPY AND RESEARCH SERCIVES

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 1265858534 NPI number — CENTER FOR SYSTEMATIC THERAPY AND RESEARCH SERCIVES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR SYSTEMATIC THERAPY AND RESEARCH SERCIVES
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:
1265858534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 S 333RD ST
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98003-6309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-929-1543
Provider Business Mailing Address Fax Number:
866-311-9279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 S 333RD ST
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-929-1543
Provider Business Practice Location Address Fax Number:
866-311-9279
Provider Enumeration Date:
03/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
253-929-1543

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LH60323507 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: PY00002013 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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