Healthcare Provider Details

I. General information

NPI: 1053545343
Provider Name (Legal Business Name): PROACTIVE PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S JEFFERSON ST STE 163
SPOKANE WA
99204-3143
US

IV. Provider business mailing address

400 S JEFFERSON ST STE 163
SPOKANE WA
99204-3143
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-5733
  • Fax: 509-327-5191
Mailing address:
  • Phone: 509-456-5733
  • Fax: 509-327-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE DAYMONT
Title or Position: CEO
Credential:
Phone: 509-869-3266