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NPI Code Detail

MEDICARE: INNOVATIVE MENTAL HEALTH AND PAIN CARE, LLC

MEDICARE: INNOVATIVE MENTAL HEALTH AND PAIN CARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP60521323WA

General Provider Information

NPI Number : 1326495490
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE MENTAL HEALTH AND PAIN CARE, LLC
Provider Business Mailing Address
First Line : 1201 PACIFIC AVE STE 600
Second Line :
City : TACOMA
State : WA
Zip : 98402-4384
Country : US
Telephone Number : 253-358-3143
Fax Number : 253-514-6239
Provider Business Practice Location Address
First Line : 1201 PACIFIC AVE STE 600
Second Line :
City : TACOMA
State : WA
Zip : 98402-4384
Country : US
Telephone Number : 253-358-3143
Fax Number : 253-514-6239
Authorized Official
Title or Position : OWNER
Name : MICHAEL J TEFFT
Credential :
Telephone Number : 253-358-3143
Provider Enumeration Date : 05/19/2016
Last Update Date : 10/28/2024

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