Healthcare Provider Details

I. General information

NPI: 1093538860
Provider Name (Legal Business Name): PUGET SOUND PEER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3931
US

IV. Provider business mailing address

10034 NE 142ND PL
KIRKLAND WA
98034-9423
US

V. Phone/Fax

Practice location:
  • Phone: 206-251-7953
  • Fax:
Mailing address:
  • Phone: 206-600-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA JUSTICE CHAMPION
Title or Position: EXECUTIVE DIRECTOR
Credential: CPC, AAC
Phone: 206-251-7953