Basic Information
Provider Information
NPI: 1639321995
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOWEN
FirstName: KAY
MiddleName: THERESA
NamePrefix: MS.
NameSuffix:  
Credential: MA, AAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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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: 505 29TH ST SE
Address2: SOUND MENTAL HEALTH - CHARTLEY
City: AUBURN
State: WA
PostalCode: 980027541
CountryCode: US
TelephoneNumber: 2538767650
FaxNumber: 2538767651
Other Information
ProviderEnumerationDate: 10/17/2008
LastUpdateDate: 09/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XCG60127046WAY Behavioral Health & Social Service ProvidersCounselorMental Health
101Y00000XCG60127046WAN Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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