Basic Information
| Provider Information | |||||||||
| NPI: | 1912663162 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOLAKAI BEHAVIORAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25852 243RD AVE SE | ||||||||
| Address2: | |||||||||
| City: | MAPLE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980388473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089225597 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25852 243RD AVE SE | ||||||||
| Address2: | |||||||||
| City: | MAPLE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980388473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089225597 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2021 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | POLLOCK | ||||||||
| AuthorizedOfficialFirstName: | BOBBI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8089225597 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LBA, BCBA, MSW | ||||||||
| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.