Healthcare Provider Details

I. General information

NPI: 1619717436
Provider Name (Legal Business Name): INGENUITY - THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 509-262-5774
  • Fax:
Mailing address:
  • Phone: 509-262-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DUSTIN HAYWOOD
Title or Position: OWNER
Credential: LICSW
Phone: 509-262-5774