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General NPI Number Information
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NPI Number | 1053035105
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Entity Type | Organization
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Legal Business Name | MARISSA OHLSTROM, PSYD, PLLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 4860 RAINIER AVENUE S STE C
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City | SEATTLE
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State | WA
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Zip | 98118
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Country | US
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Telephone | 206-531-4548
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Fax |
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Provider Business Mailing Address
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Address Line | 3518 FREMONT AVE N # 325
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City | SEATTLE
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State | WA
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Zip | 98103-8814
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Country | US
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Telephone | 206-531-4548
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Fax |
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Authorized Official
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Title or Position | PROVIDER/SOLE OWNER
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Name | DR. MARISSA OHLSTROM
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Credential | PSYD
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Telephone | 206-531-4548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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