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General NPI Number Information
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NPI Number | 1396468567
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Entity Type | Organization
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Legal Business Name | PUGET SOUND EXPRESSIVE ARTS THERAPY, PLLC
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 5450 CALIFORNIA AVE SW STE 101
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City | SEATTLE
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State | WA
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Zip | 98136-1577
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Country | US
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Telephone | 206-452-7442
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Fax | 206-452-7442
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Provider Business Mailing Address
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Address Line | 5450 CALIFORNIA AVE SW STE 101
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City | SEATTLE
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State | WA
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Zip | 98136-1577
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Country | US
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Telephone | 206-452-7442
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Fax | 206-452-7442
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Authorized Official
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Title or Position | OWNER - PSYCHOTHERAPIST
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Name | MANDY LEE PARIDA
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Credential | LMHC
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Telephone | 541-350-8489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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