Eastside Social Skills Therapy

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EASTSIDE SOCIAL SKILLS THERAPY

Practice address

5431 236TH PL SE
Issaquah, WA 98029-6844

Phone

(509) 366-5572

NPI assigned

Jan 20, 2017

Organization subpart

No

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

Authorized official

Name

Penny J Lathum, M.,ED, BCBA, AAC

Title

Owner/Director

Phone

(206) 380-3009

Specialties & licenses 1

Addresses

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.

• Eastside Social Skills Therapy LLC

  • Preferred Provider Organization
  • Issaquah, WA
  • NPI 1659765816
  NPD tax ID

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484870400000",
    "number": "1770020331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5431 236TH PL SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980296844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5431 236TH PL SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980296844",
            "telephone_number": "509-366-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE SOCIAL SKILLS THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-20",
        "last_updated": "2017-01-20",
        "status": "A",
        "authorized_official_last_name": "LATHUM",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "206-380-3009",
        "authorized_official_credential": "M.,ED, BCBA, AAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastside Family Institute
• Eastside Fire & Rescue
• Eastside Ideal Health Issaquah, PLLC
• Eastside Insight, PLLC
• Eastside Medical Group, LLC
• Eastside Social Skills Therapy LLC
• Eastside Therapy Associates LLC
• Eastside Therapy Services
• Jessica Lynn Ebberson
• Ryan Michael Ebisu, MD

• Community/Behavioral Health Agency in Issaquah, WA
• Providers in Issaquah, 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 Jan 20, 2017; 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.