Healthcare Provider Details

I. General information

NPI: 1821806761
Provider Name (Legal Business Name): KINGS QUEENS & CELEBRITIES, SPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13718 PACIFIC AVE S
TACOMA WA
98444-4746
US

IV. Provider business mailing address

PO BOX 44836
TACOMA WA
98448-0836
US

V. Phone/Fax

Practice location:
  • Phone: 253-536-4580
  • Fax: 253-584-2469
Mailing address:
  • Phone: 253-536-4580
  • Fax: 253-584-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUEITA BELL
Title or Position: PRINCIPLE / CAO / GENERAL MANAGER
Credential: CPC, CM
Phone: 253-536-4580