NPIMap

Organization Active NPI

Community Psychiatric Clinic Inc

  • Community/Behavioral Health Agency
  • Seattle, WA
National Provider Identifier
1629120159
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
117700 Issued in WA
Legal business name
COMMUNITY PSYCHIATRIC CLINIC INC
Practice address
11000 Lake City Way NE
Suite 200
Seattle, WA 98125-6748
Phone
(206) 461-3614
Fax
(206) 634-0094
NPI assigned
Jan 17, 2007
Last updated
Sep 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Authorized official

Name
Miss Kelcey Symons
Title
Admin Supervisor
Phone
(206) 545-2387

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 035 WA
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 17087600 WA
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 17087500 WA
Community/Behavioral Health Agency 251S00000X 117700 WA Primary

Addresses

Primary practice location

11000 Lake City Way NE
Suite 200
Seattle, WA 98125-6748

Mailing address

11000 Lake City Way NE
Suite 200
Seattle, WA 98125-6748
Phone (206) 461-3614

Other identifiers 6

IdentifierTypeStateIssuer
1992650MedicaidWA
1992890MedicaidWA
1981802MedicaidWA
1992668MedicaidWA
1992874MedicaidWA
1992882MedicaidWA

National Provider Directory

National Provider Directory

Locations

10700 Meridian Ave N
Ste G11
Seattle, WA 98133
Phone (206) 302-2900

11000 Lake City Way NE
Seattle, WA 98125
Phone (206) 461-3614

401 2nd Ave W
Seattle, WA 98119

4120 Stone Way N
Seattle, WA 98103
Phone (206) 461-3707

418 2nd Avenue Ext S
Seattle, WA 98104
Phone (206) 461-3209

4319 Stone Way N
Seattle, WA 98103
Phone (206) 461-3614

Practitioners & affiliated clinicians

Practitioners 161

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 161

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1629120159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 LAKE CITY WAY NE",
            "address_2": "SUITE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981256748",
            "telephone_number": "206-461-3614",
            "fax_number": "206-634-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11000 LAKE CITY WAY NE",
            "address_2": "SUITE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981256748",
            "telephone_number": "206-461-3614",
            "fax_number": "206-634-0094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY PSYCHIATRIC CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "SYMONS",
        "authorized_official_first_name": "KELCEY",
        "authorized_official_title_or_position": "ADMIN SUPERVISOR",
        "authorized_official_telephone_number": "206-545-2387",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WA",
            "license": "035",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "17087600",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "17087500",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "117700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992650",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992890",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1981802",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992668",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992874",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992882",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; 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.