Healthcare Provider Details

I. General information

NPI: 1366207904
Provider Name (Legal Business Name): SERENITY BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 176TH ST E APT K308
TACOMA WA
98446-2847
US

IV. Provider business mailing address

4801 176TH ST E APT K308
TACOMA WA
98446-2847
US

V. Phone/Fax

Practice location:
  • Phone: 770-572-2098
  • Fax:
Mailing address:
  • Phone: 770-572-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE NDUTA NDUATI
Title or Position: PRESIDENT
Credential: NURSE PRACTITIONER
Phone: 770-572-2098