Healthcare Provider Details

I. General information

NPI: 1205422318
Provider Name (Legal Business Name): INDIGENOUS LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LENORA ST # 980
SEATTLE WA
98121-2411
US

IV. Provider business mailing address

300 LENORA ST # 980
SEATTLE WA
98121-2411
US

V. Phone/Fax

Practice location:
  • Phone: 54-317-4956
  • Fax:
Mailing address:
  • Phone: 605-431-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAYLEE TROTTIER
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D
Phone: 605-431-7495