Basic Information
Provider Information
NPI: 1629219019
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAPPA
FirstName: BROOKE
MiddleName: NICHOL
NamePrefix:  
NameSuffix:  
Credential: BA, RC
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 1600 E OLIVE ST
Address2: SOUND MENTAL HEALTH
City: SEATTLE
State: WA
PostalCode: 981222735
CountryCode: US
TelephoneNumber: 2063022200
FaxNumber: 2063022210
Practice Location
Address1: 6100 SOUTHCENTER BLVD
Address2: SOUND MENTAL HEALTH, SUITE 200
City: TUKWILA
State: WA
PostalCode: 981882441
CountryCode: US
TelephoneNumber: 2064447938
FaxNumber: 2064447810
Other Information
ProviderEnumerationDate: 03/13/2009
LastUpdateDate: 03/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XRC60068610WAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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