| Pacific Therapy Group, Pllc | |
|
1601 116th Ave Ne Suite 114 Bellevue WA 98004-3010 | |
| (425) 454-7541 | |
| (425) 454-1142 |
| Full Name | Pacific Therapy Group, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1601 116th Ave Ne, Bellevue, Washington |
| Authorized Official Name and Position | Mary Anderson (OWNER/MEMBER) |
| Authorized Official Contact | 4254547541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Therapy Group, Pllc 1601 116th Ave Ne Suite 114 Bellevue WA 98004-3010 Ph: (425) 454-7541 | Pacific Therapy Group, Pllc 1601 116th Ave Ne Suite 114 Bellevue WA 98004-3010 Ph: (425) 454-7541 |
| NPI Number | 1053645754 |
|---|---|
| Provider Enumeration Date | 09/28/2009 |
| Last Update Date | 05/21/2012 |
| Medicare PECOS PAC ID | 4789847278 |
|---|---|
| Medicare Enrollment ID | O20120521000238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053645754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Washington) | Primary |
| Provider Name | Mary N Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891857520 PECOS PAC ID: 5698938181 Enrollment ID: I20120521000535 |
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