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General NPI Number Information
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NPI Number | 1578453197
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Entity Type | Organization
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Legal Business Name | LIBER PSYCHIATRY LLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 2027 196TH ST SW STE A205
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City | LYNNWOOD
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State | WA
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Zip | 98036-7073
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Country | US
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Telephone | 360-523-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 115 E MAIN ST STE A1B
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City | BUFORD
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State | GA
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Zip | 30518-5727
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MARIAM ODIGWE
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Credential |
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Telephone | 360-523-2820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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