=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164972873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARITY WELLNESS CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2016
-----------------------------------------------------
Last Update Date | 05/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 NE 4TH ST STE 111
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98056-4100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-686-9580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 262 SENECA AVE NW
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-5151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-686-9580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | CATHERINE WANG-MORIEN
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 425-686-9580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 60260504
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------