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

Last updated

Jan 20, 2017By the provider in NPPES

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, AACNPI 1508111766

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

Practitioners 1

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.

• Penny Jane Lathum, M.ED., BCBA

  • Behavior Analyst
  • Issaquah, WA
  • NPI 1508111766
  Authorized official Same address or phone

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 (Rose Gillis, PLLC)
• Eastside Medical Group, LLC
• Eastside Social Skills Therapy LLC
• Eastside Therapy Associates LLC (Eastside Occupational Therapy)
• 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.