Healthcare Provider Details

I. General information

NPI: 1639826837
Provider Name (Legal Business Name): EMERALD ISLE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST STE 17
TACOMA WA
98409-7252
US

IV. Provider business mailing address

4301 S PINE ST STE 17
TACOMA WA
98409-7252
US

V. Phone/Fax

Practice location:
  • Phone: 720-204-8510
  • Fax: 720-828-6114
Mailing address:
  • Phone: 720-204-8510
  • Fax: 720-828-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SHARON L. ALLEN
Title or Position: OWNER
Credential: PHD
Phone: 720-204-8510