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General NPI Number Information
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NPI Number | 1043021595
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Entity Type | Organization
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Legal Business Name | ICARE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 19435 68TH AVE S STE S102
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City | KENT
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State | WA
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Zip | 98032-2114
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Country | US
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Telephone | 253-414-1983
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Fax | 425-616-1166
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Provider Business Mailing Address
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Address Line | 19435 68TH AVE S STE S102
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City | KENT
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State | WA
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Zip | 98032-2114
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Country | US
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Telephone | 253-414-1983
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Fax | 425-616-1166
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KEITH HO
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Credential |
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Telephone | 714-251-7612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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