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General NPI Number Information
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NPI Number | 1124503735
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Entity Type | Organization
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Legal Business Name | PREMIER THERAPEUTIC EXPERIENCE
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 1400 112TH AVE SE STE 100
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City | BELLEVUE
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State | WA
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Zip | 98004-6901
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Country | US
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Telephone | 507-254-7893
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Fax |
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Provider Business Mailing Address
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Address Line | 3213 HARBOR AVE SW UNIT 103
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City | SEATTLE
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State | WA
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Zip | 98126-4600
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Country | US
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Telephone | 507-254-7893
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Fax |
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Authorized Official
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Title or Position | MANAGER OF OPERATIONS
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Name | HEATHER MOIR
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Credential |
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Telephone | 507-254-7893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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