Provider Demographics
NPI:1447494455
Name:SEASIDE MENTAL HEALTH AND PSYCHIATRIC SERVICES, PLLC
Entity type:Organization
Organization Name:SEASIDE MENTAL HEALTH AND PSYCHIATRIC SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MONTAPERTO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-903-1371
Mailing Address - Street 1:772 CAMANO AVE
Mailing Address - Street 2:SUITE 201B-B
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9288
Mailing Address - Country:US
Mailing Address - Phone:425-903-1371
Mailing Address - Fax:
Practice Address - Street 1:828 2ND ST
Practice Address - Street 2:SUITE J
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1610
Practice Address - Country:US
Practice Address - Phone:425-903-1371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 30007333261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8880270Medicare PIN