Healthcare Provider Details

I. General information

NPI: 1073198602
Provider Name (Legal Business Name): NEW ERA MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 200TH ST SW STE F
LYNNWOOD WA
98036-6608
US

IV. Provider business mailing address

4630 200TH ST SW STE F
LYNNWOOD WA
98036-6608
US

V. Phone/Fax

Practice location:
  • Phone: 425-510-1196
  • Fax:
Mailing address:
  • Phone: 425-510-1196
  • Fax: 425-582-8966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEXANDRIA GOMEZ
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 425-670-0280