Basic Information
| Provider Information | |||||||||
| NPI: | 1366929762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONSEJO COUSELING AND REFERRAL SERVICE - BELLEVUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3808 S ANGELINE ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981181712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064614880 | ||||||||
| FaxNumber: | 2064616989 | ||||||||
| Practice Location | |||||||||
| Address1: | 13343 BEL-RED ROAD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980052327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256790801 | ||||||||
| FaxNumber: | 4256790802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2018 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | PAREDES | ||||||||
| AuthorizedOfficialFirstName: | MARIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2064614880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | WA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 200186 | 01 | WA | DBHR SITE LICENSE ID | OTHER |