# P. BONEBRAKE MD CHILD AND ADOLESCENT PSYCHIATRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043620925
- **Authorized official:** DR. PORTIA BONEBRAKE M.D. (SOLE MEMBER)
- **Authorized official phone:** (425) 449-9710

## Contact information

- **Practice address:** 17220 127TH PL NE STE 101A, WOODINVILLE, WA 98072-7965
- **Practice address phone:** (425) 449-9710
- **Mailing address:** PO BOX 113, KIRKLAND, WA 98083-0113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 60097435 | WA | Yes |

## Other

- **Enumeration date:** 05/01/2014
- **Last updated:** 05/01/2014