Healthcare Provider Details

I. General information

NPI: 1447618053
Provider Name (Legal Business Name): LLC COURAGE 2B
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1764 N JAMES ST
TACOMA WA
98406-1508
US

IV. Provider business mailing address

920 ALDER AVE STE.207
SUMNER WA
98390-1401
US

V. Phone/Fax

Practice location:
  • Phone: 253-208-7644
  • Fax:
Mailing address:
  • Phone: 253-363-2244
  • Fax: 253-883-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60477833
License Number StateWA

VIII. Authorized Official

Name: DR. KATIA RAMIREZ
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 253-363-2244