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EASTSIDE BEHAVIORAL MEDICINE, PLLC

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Company Details

Legal Name: EASTSIDE BEHAVIORAL MEDICINE, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Inactive
Formation/ Registration Date: November 3rd 2009
Date of Dissolution: March 1st 2011
Expiration date: 30 Nov 2010
UBI Number: 602 967 118
ZIP code: 98008
City: Bellevue
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 15600 NE 8TH ST #B1-385, BELLEVUE, WA, 98008, UNITED STATES

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Registered Agent Information

Name Role Address
MICHAELLARSON Registered Agent 1200 5TH AVE #1217, SEATTLE, WA, 98101, UNITED STATES

Key Officers & Management

Name Role Address
DARLA CAPETILLO Governing Person 15600 NE 8TH ST #B1-385, BELLEVUE, WA, 98008, UNITED STATES
CYNTHIA MASON Governing Person 15600 NE 8TH ST #B1-385, BELLEVUE, WA, 98008, UNITED STATES

National Provider Identifier

NPI Number:
1952633737

Authorized Person:

Name:
DR. DARLA CAPETILLO
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
103T00000X - Psychologist
Is Primary:
Yes

Contacts:

Fax:
4252830486
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