Healthcare Provider Details

I. General information

NPI: 1053701334
Provider Name (Legal Business Name): PREMIER PSYCHIATRIC SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE SUITE 5300
SPOKANE VALLEY WA
99216-2830
US

IV. Provider business mailing address

16201 E INDIANA AVE SUITE 5300
SPOKANE VALLEY WA
99216-2830
US

V. Phone/Fax

Practice location:
  • Phone: 509-919-4060
  • Fax: 509-789-9013
Mailing address:
  • Phone: 509-919-4060
  • Fax: 509-789-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA J RAVASIA
Title or Position: OWNER
Credential: MD
Phone: 509-919-4060