Healthcare Provider Details

I. General information

NPI: 1760222921
Provider Name (Legal Business Name): PRIMROSE THERAPEUTIC SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 6TH AVE STE 100
TACOMA WA
98405-3300
US

IV. Provider business mailing address

1712 6TH AVE STE 100
TACOMA WA
98405-3300
US

V. Phone/Fax

Practice location:
  • Phone: 305-549-0566
  • Fax:
Mailing address:
  • Phone: 305-549-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: OSMEL E CAMPOS PEREZ
Title or Position: CHIEFT OPERATING OFFICER/OWNER
Credential:
Phone: 305-549-0566