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General NPI Number Information
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NPI Number | 1497168371
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Entity Type | Organization
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Legal Business Name | PUYALLUP PSYCHOTHERAPEUTIC ALLIANCE
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 104 W MAIN 202
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City | PUYALLUP
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State | WA
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Zip | 98371-8904
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Country | US
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Telephone | 253-686-1319
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Fax |
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Provider Business Mailing Address
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Address Line | 104 W MAIN 202
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City | PUYALLUP
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State | WA
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Zip | 98371-8904
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Country | US
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Telephone | 253-686-1319
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ANAHITA ARMIN
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Credential | LMHC
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Telephone | 253-686-1319
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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 | MHC.LH.60305323
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License Number State | WA
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