Healthcare Provider Details

I. General information

NPI: 1427966209
Provider Name (Legal Business Name): NORTHFORM PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S ARTHUR ST STE 415
SPOKANE WA
99202-2220
US

IV. Provider business mailing address

PO BOX 62
MEDICAL LAKE WA
99022-0062
US

V. Phone/Fax

Practice location:
  • Phone: 509-400-4895
  • Fax: 509-223-7534
Mailing address:
  • Phone: 509-400-4895
  • Fax: 509-223-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MITCHELL CORBET
Title or Position: SOLE MEMBER
Credential: ARNP, PMHNP-BC
Phone: 503-310-6328