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General NPI Number Information
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NPI Number | 1376340430
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Entity Type | Organization
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Legal Business Name | PSYCHED UP SUCCESS LLC
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 7558 PRESSENTIN RANCH DR
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City | CONCRETE
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State | WA
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Zip | 98237-8803
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Country | US
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Telephone | 425-608-1867
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Fax | 425-845-2375
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | CONCRETE
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State | WA
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Zip | 98237-0247
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Country | US
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Telephone | 425-608-1867
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Fax | 425-845-2375
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Authorized Official
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Title or Position | PRESIDENT
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Name | JODIE LYNN SOLBERG
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Credential | CHT
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Telephone | 425-608-1867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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