P. Bonebrake MD Child and Adolescent Psychiatry LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

60097435 Issued in WA

Legal business name

P. BONEBRAKE MD CHILD AND ADOLESCENT PSYCHIATRY LLC

Practice address

17220 127TH PL NE Ste 101a
Woodinville, WA 98072-7965

Phone

(425) 449-9710

NPI assigned

May 1, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Portia Bonebrake, M.D.

Title

Sole Member

Phone

(425) 449-9710

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398902400000",
    "number": "1043620925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 113",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980830113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17220 127TH PL NE STE 101A",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980727965",
            "telephone_number": "425-449-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P. BONEBRAKE MD CHILD AND ADOLESCENT PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-01",
        "last_updated": "2014-05-01",
        "status": "A",
        "authorized_official_last_name": "BONEBRAKE",
        "authorized_official_first_name": "PORTIA",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "425-449-9710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WA",
            "license": "60097435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Woodinville, WA
• Providers in Woodinville, WA by specialty
• Adolescent and Children Mental Health Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.