Healthcare Provider Details

I. General information

NPI: 1235792326
Provider Name (Legal Business Name): WELLPSYCHE SEATTLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 2ND AVE STE 800
SEATTLE WA
98104-1573
US

IV. Provider business mailing address

1055 WILSHIRE BLVD STE 1705
LOS ANGELES CA
90017-5600
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-0670
  • Fax:
Mailing address:
  • Phone: 310-871-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEL MOSTAFAVI
Title or Position: CEO
Credential: MD
Phone: 949-400-2488