MEDICARE: NEUROSTIM TMS, PS

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1710415617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSTIM TMS, PS

Provider Business Mailing Address
First Line	:	9116 GRAVELLY LAKE DR SW STE 102
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-200-5764
Fax Number	:	253-590-4298

Provider Business Practice Location Address
First Line	:	9116 GRAVELLY LAKE DR SW STE 102
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-200-5763
Fax Number	:	253-590-4298

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	TASHA MORRIS
Credential	:	M.D.
Telephone Number	:	425-256-2967

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	09/20/2023

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