Healthcare Provider Details

I. General information

NPI: 1720455546
Provider Name (Legal Business Name): BALANCED LIVING PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 34TH AVE STE 209
SEATTLE WA
98122-5137
US

IV. Provider business mailing address

1126 34TH AVE STE 209
SEATTLE WA
98122-5137
US

V. Phone/Fax

Practice location:
  • Phone: 206-914-9254
  • Fax: 425-223-5240
Mailing address:
  • Phone: 206-914-9254
  • Fax: 425-223-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMD60147234
License Number StateWA

VIII. Authorized Official

Name: MICHELLE ZIPPERMAN
Title or Position: OWNER, PHYSICIAN
Credential: M.D.
Phone: 206-914-4773