NPIMap

Organization Active NPI

Eastside Social Skills Therapy LLC

  • Preferred Provider Organization
  • Issaquah, WA
National Provider Identifier
1659765816
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
EASTSIDE SOCIAL SKILLS THERAPY LLC
Practice address
5436 232ND Ave SE
Issaquah, WA 98029
Phone
(206) 380-3009
NPI assigned
Mar 26, 2015
Last updated
Mar 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

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

Authorized official

Name
Penny J Lathum, M.ED, BCBANPI 1508111766
Title
Owner
Phone
(206) 380-3009

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X NU Primary

Addresses

Primary practice location

5436 232ND Ave SE
Issaquah, WA 98029

Mailing address

5436 232ND Ave SE
Issaquah, WA 98029

National Provider Directory

National Provider Directory
Tax ID family
Eastside Social Skills Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1445 NW Mall St
Ste 2
Issaquah, WA 98027
Phone (425) 651-8117

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1659765816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5436 232ND AVE SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5436 232ND AVE SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98029",
            "telephone_number": "206-380-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE SOCIAL SKILLS THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-26",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "LATHUM",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-380-3009",
        "authorized_official_credential": "M.ED, BCBA"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.