NPIMap

Organization Active NPI

Greater Lakes Mental Health Foundation Inc

Doing business as Greater Lakes Mental Healthcare

  • Mental Illness Community Based Residential Treatment Facility
  • Lakewood, WA
National Provider Identifier
1225039811
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
GREATER LAKES MENTAL HEALTH FOUNDATION INC
Doing business as
Greater Lakes Mental Healthcare
Practice address
9330 59TH Ave SW
Lakewood, WA 98499-2858
Phone
(253) 581-7020
NPI assigned
Aug 3, 2005
Last updated
Aug 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Authorized official

Name
William Glenn Robertson
Title
Ceo
Phone
(253) 403-1272

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

9330 59TH Ave SW
Lakewood, WA 98499-2858

Mailing address

P.O. Box 5299
Ms: 820-5-Pco
Tacoma, WA 98415-0299

Other identifiers 1

IdentifierTypeStateIssuer
1043327MedicaidWA

Other names 1

  • Greater Lakes Mental Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315001162 WA Part B Supplier - Clinic/Group Practice 7315836350 Receives reassigned benefits from 66 practitioners
Practice locations: Lakewood, WA; Tacoma, WA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3434 Martin Way E
Ste B
Olympia, WA 98506
Phone (253) 581-7020

Practitioners & affiliated clinicians

Practitioners 68

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1225039811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5299",
            "address_2": "MS: 820-5-PCO",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984150299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 59TH AVE SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992858",
            "telephone_number": "253-581-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER LAKES MENTAL HEALTH FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "253-403-1272"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043327",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Lakes Mental Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greater Lakes Mental Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.