Pacific Mental Health

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LH60320548 Issued in WA

Legal business name

PACIFIC MENTAL HEALTH

Practice address

316 Main St
Suite A1
Edmonds, WA 98020-3197

Phone

(206) 658-3920

NPI assigned

Dec 2, 2014

Organization subpart

No

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

Authorized official

Name

Carolyn A Russo, MS, LMHC

Title

Part Owner

Phone

(206) 658-3920

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1679970925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 NW 201ST ST",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981772012",
            "telephone_number": "206-658-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 MAIN ST",
            "address_2": "SUITE A1",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980203197",
            "telephone_number": "206-658-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "206-658-3920",
        "authorized_official_credential": "MS, LMHC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "LH60500437",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "LH60320548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Ott, MSW, LSWAIC
• Sarah Elizabeth Ouano, ND
• Glen R Owen, O.D.
• Tracy Ozanich, LMP
• Pacific Healthcare, LLC
• Pacific Nutrition & Wellness
• Pacific Vascular Incorporated
• Justin M Pagan, D.D.S., M.S.D.
• Michael John Pagan, PT
• Pain Care, Inc.

• Community/Behavioral Health Agency in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Community/Behavioral Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.