Provider Demographics
NPI:1861253692
Name:BLUE TOPAZ THERAPY
Entity type:Organization
Organization Name:BLUE TOPAZ THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BREDA
Authorized Official - Middle Name:KAILYN
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHCA
Authorized Official - Phone:425-681-6885
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-0132
Mailing Address - Country:US
Mailing Address - Phone:206-533-3048
Mailing Address - Fax:
Practice Address - Street 1:9920 NE 119TH ST APT 109
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4244
Practice Address - Country:US
Practice Address - Phone:425-681-6885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)