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General NPI Number Information
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NPI Number | 1053545343
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Entity Type | Organization
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Legal Business Name | PROACTIVE PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 400 S JEFFERSON ST STE 163
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City | SPOKANE
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State | WA
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Zip | 99204-3143
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Country | US
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Telephone | 509-456-5733
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Fax | 509-327-5191
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Provider Business Mailing Address
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Address Line | 400 S JEFFERSON ST STE 163
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City | SPOKANE
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State | WA
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Zip | 99204-3143
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Country | US
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Telephone | 509-456-5733
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Fax | 509-327-5191
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Authorized Official
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Title or Position | CEO
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Name | DENISE DAYMONT
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Credential |
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Telephone | 509-869-3266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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