Healthcare Provider Details

I. General information

NPI: 1720483480
Provider Name (Legal Business Name): THIRA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 09/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 SE 6TH STREET STE 200
BELLEVUE WA
98004-6423
US

IV. Provider business mailing address

11400 SE 6TH STREET STE 200
BELLEVUE WA
98004-6423
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-1199
  • Fax: 425-454-8779
Mailing address:
  • Phone: 425-454-1199
  • Fax: 425-454-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEHRI DAMAVANDI MOORE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 206-930-2616