MEDICARE: BROOKE HEYMAN INTEGRATIVE PSYCHIATRY, P.C.

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)

General Provider Information

NPI Number	:	1760958474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKE HEYMAN INTEGRATIVE PSYCHIATRY, P.C.

Provider Business Mailing Address
First Line	:	4624 42ND AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1628
Country	:	US
Telephone Number	:	206-257-3707
Fax Number	:	206-267-0984

Provider Business Practice Location Address
First Line	:	1417 NW 54TH ST STE 460
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-3562
Country	:	US
Telephone Number	:	206-257-3707
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BROOKE HEYMAN
Credential	:	ARNP
Telephone Number	:	206-257-3707

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	12/12/2018

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