Basic Information
| Provider Information | |||||||||
| NPI: | 1962507442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASIAN COUNSELING AND REFERRAL SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3639 MARTIN LUTHER KING JR. WAY SOUTH | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981446847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066957600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3639 MARTIN LUTHER KING JR. WAY SOUTH | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981446847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066957600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 11/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | HAN | ||||||||
| AuthorizedOfficialFirstName: | YOON JOO | ||||||||
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| AuthorizedOfficialTitleorPosition: | BEHAVIORAL HEALTH PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2066957591 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 17100100 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 031 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 031 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 031 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 261QM0850X | 019 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 019 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 363LP0808X | 031 | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 261QM0801X | 019 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1981505 | 05 | WA | MEDICAID |