Basic Information
| Provider Information | |||||||||
| NPI: | 1720132079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSS-WESTON | ||||||||
| FirstName: | AL | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34584 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092417349 | ||||||||
| FaxNumber: | 5902417628 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 S PINE ST | ||||||||
| Address2: | STE301 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984097264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534766500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LF00001137 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.