| Blu Orchard Therapy Of Washington | |
|
1800 Cooper Point Rd Sw Ste 22 Olympia WA 98502-1179 | |
| (801) 824-2421 | |
| Not Available |
| Full Name | Blu Orchard Therapy Of Washington |
|---|---|
| Speciality | Clinic/Center |
| Location | 1800 Cooper Point Rd Sw Ste 22, Olympia, Washington |
| Authorized Official Name and Position | Colin Jackson (MANAGER) |
| Authorized Official Contact | 8018242421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blu Orchard Therapy Of Washington 7622 Ostrander Ct Se Olympia WA 98501-9690 Ph: (801) 824-2421 | Blu Orchard Therapy Of Washington 1800 Cooper Point Rd Sw Ste 22 Olympia WA 98502-1179 Ph: (801) 824-2421 |
| NPI Number | 1760217707 |
|---|---|
| Provider Enumeration Date | 09/06/2024 |
| Last Update Date | 09/25/2024 |
| Certification Date | 09/25/2024 |
| Medicare PECOS PAC ID | 0345778114 |
|---|---|
| Medicare Enrollment ID | O20250107001478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760217707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Atilade A Owolabi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629648266 PECOS PAC ID: 0042753204 Enrollment ID: I20240617002811 |
| Provider Name | Kacie Zediker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922347814 PECOS PAC ID: 8426351891 Enrollment ID: I20250107001759 |
| Provider Name | Patricia Lynn Bailey |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1225504137 PECOS PAC ID: 5799213377 Enrollment ID: I20250109003150 |
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