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General NPI Number Information
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NPI Number | 1093538860
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Entity Type | Organization
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Legal Business Name | PUGET SOUND PEER
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 28826 28TH PL S
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7901
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Country | US
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Telephone | 253-250-9687
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4811
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City | FEDERAL WAY
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State | WA
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Zip | 98063-4811
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JESSICA JUSTICE CHAMPION
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Credential | CPC, AAC
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Telephone | 206-251-7953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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