Healthcare Provider Details

I. General information

NPI: 1649076050
Provider Name (Legal Business Name): PSYCHIATRIC CONNECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6274 40TH ST. CT.
E FIFE WA
98424
US

IV. Provider business mailing address

300 LENORA ST
SEATTLE WA
98121-2411
US

V. Phone/Fax

Practice location:
  • Phone: 206-699-8261
  • Fax:
Mailing address:
  • Phone: 206-699-8261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PRAVEEN BODAKUNTA
Title or Position: OWNER
Credential:
Phone: 206-699-8261