Healthcare Provider Details

I. General information

NPI: 1104338144
Provider Name (Legal Business Name): VEST SEATTLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 156TH ST NE
MARYSVILLE WA
98271-4831
US

IV. Provider business mailing address

3955 156TH STREET NE
MARYSVILLE WA
98271-4831
US

V. Phone/Fax

Practice location:
  • Phone: 844-202-5555
  • Fax: 360-542-2254
Mailing address:
  • Phone: 360-651-6400
  • Fax: 360-542-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ALLEN KRESCH
Title or Position: MANAGER
Credential: M.D.
Phone: 212-243-5565