Healthcare Provider Details

I. General information

NPI: 1396658662
Provider Name (Legal Business Name): INTEGRATIVE MENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16734 JUANITA DR NE
KENMORE WA
98028-4211
US

IV. Provider business mailing address

16734 JUANITA DR NE
KENMORE WA
98028-4211
US

V. Phone/Fax

Practice location:
  • Phone: 206-303-0325
  • Fax:
Mailing address:
  • Phone: 206-303-0325
  • 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: PEIMANEH ABDOLHOSSEINI
Title or Position: OWNER
Credential: DNP, PMHNP-BC
Phone: 206-303-0325