Healthcare Provider Details

I. General information

NPI: 1588512404
Provider Name (Legal Business Name): RESILIENT ADHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18707 44TH PARK SE
BOTHELL WA
98012-7988
US

IV. Provider business mailing address

5608 17TH AVE NW STE 2024
SEATTLE WA
98107-5232
US

V. Phone/Fax

Practice location:
  • Phone: 564-234-3123
  • Fax:
Mailing address:
  • Phone: 564-234-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES CLARK
Title or Position: OWNER PROVIDER
Credential: ARNP
Phone: 564-234-3123