Healthcare Provider Details

I. General information

NPI: 1659827046
Provider Name (Legal Business Name): PEPPERMINTZ CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 CALIFORNIA AVE SW # 214
SEATTLE WA
98116-3780
US

IV. Provider business mailing address

3614 CALIFORNIA AVE SW # 214
SEATTLE WA
98116-3780
US

V. Phone/Fax

Practice location:
  • Phone: 206-946-1685
  • Fax:
Mailing address:
  • Phone: 206-946-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JOSLYN CYNKUS MINTZ
Title or Position: CEO
Credential: PHD, BCBA-D
Phone: 206-946-1685