Organization
PACIFIC MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN A RUSSO MS, LMHC (PART OWNER)
(206) 658-3920
Entity
Organization
Contact information
Practice address
316 MAIN ST, SUITE A1, EDMONDS, WA 98020-3197
(206) 658-3920
Mailing address
230 NW 201ST ST, SHORELINE, WA 98177-2012
(206) 658-3920
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LH60320548
WA
251S00000X
Community/Behavioral Health Agency
LH60500437
WA
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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