Southlake Psychiatric Center

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

14418 Issued in WA

Legal business name

SOUTHLAKE PSYCHIATRIC CENTER

Practice address

1400 Talbot Rd S
Suite 203
Renton, WA 98055-4291

Phone

(425) 235-7383

Fax

(425) 228-2169

NPI assigned

Dec 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Edward Dunne, M.D.

Title

Owner

Phone

(425) 235-7383

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871651042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 TALBOT RD S",
            "address_2": "SUITE 203",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980554291",
            "telephone_number": "425-235-7383",
            "fax_number": "425-228-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 TALBOT RD S",
            "address_2": "SUITE 203",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980554291",
            "telephone_number": "425-235-7383",
            "fax_number": "425-228-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE PSYCHIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUNNE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-235-7383",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WA",
            "license": "14418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0191845",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1228600",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southlake Clinic Inc PS
• Southlake Clinic Inc., P.S.
• Southlake Select, PC
• Southwest 2ND Street Healthcare LLC
• Marieme Sow
• Space for Grief
• Peter Spairring, L.M.P.

• Child & Adolescent Psychiatry Physician in Renton, WA
• Providers in Renton, WA by specialty
• Child & Adolescent Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.