Provider Demographics
NPI:1124455142
Name:SEATTLE BEHAVIOR CONSULTING & THERAPY, LLC
Entity type:Organization
Organization Name:SEATTLE BEHAVIOR CONSULTING & THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIOR ANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:KATRA
Authorized Official - Last Name:OBLAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:206-535-8876
Mailing Address - Street 1:4746 11TH AVE NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4657
Mailing Address - Country:US
Mailing Address - Phone:206-535-8876
Mailing Address - Fax:206-486-9938
Practice Address - Street 1:4746 11TH AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4657
Practice Address - Country:US
Practice Address - Phone:206-535-8876
Practice Address - Fax:206-486-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5509251S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034841Medicaid