Healthcare Provider Details

I. General information

NPI: 1508392929
Provider Name (Legal Business Name): EQUILIBRIUM PCS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 112TH AVE SE SUITE 205
BELLEVUE WA
98004-6901
US

IV. Provider business mailing address

1400 112TH AVE SE SUITE 205
BELLEVUE WA
98004-6901
US

V. Phone/Fax

Practice location:
  • Phone: 425-412-8524
  • Fax:
Mailing address:
  • Phone: 425-412-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY60664721
License Number StateWA

VIII. Authorized Official

Name: DR. ATA UL KARIM
Title or Position: OWNER
Credential: PH.D.,MSIO
Phone: 206-724-2914