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General NPI Number Information
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NPI Number | 1386596146
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Entity Type | Organization
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Legal Business Name | SC1 RS 2R6 DBA MPACT PSYCHIATRY
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 14205 SE 36TH ST
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City | BELLEVUE
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State | WA
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Zip | 98006-1596
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Country | US
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Telephone | 425-475-2663
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Fax | 425-475-2663
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Provider Business Mailing Address
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Address Line | 14205 SE 36TH ST
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City | BELLEVUE
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State | WA
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Zip | 98006-1596
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Country | US
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Telephone | 425-475-2663
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Fax | 425-475-2663
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Authorized Official
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Title or Position | DIRECTOR
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Name | TODD ROWAN
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Credential |
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Telephone | 214-551-8296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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