# EASTSIDE BEHAVIORAL MEDICINE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1952633737
- **Authorized official:** DR. DARLA CAPETILLO PHD (OWNER)
- **Authorized official phone:** (425) 454-3110

## Contact information

- **Practice address:** 1601 114TH AVE SE, SUITE 145, BELLEVUE, WA 98004-6950
- **Practice address phone:** (425) 454-3110
- **Practice address fax:** (425) 283-0486
- **Mailing address:** 1601 114TH AVE SE, SUITE 145, BELLEVUE, WA 98004-6950
- **Mailing address phone:** (425) 454-3110
- **Mailing address fax:** (425) 283-0486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 602-967-118 | WA | Yes |

## Other

- **Enumeration date:** 02/04/2010
- **Last updated:** 02/04/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0221560 | LABOR AND INDUSTRIES/CAPETILLO | WA |
| 01 | — | 0240031 | LABOR AND INDUSTRIES/MASON | WA |
| 01 | — | 602967118 | UBI | WA |