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General NPI Number Information
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NPI Number | 1669575247
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Entity Type | Organization
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Legal Business Name | JANEEN PROVAZEK MA PS
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5800 SOUNDVIEW DR STE 101-D
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City | GIG HARBOR
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State | WA
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Zip | 98335-2077
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Country | US
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Telephone | 253-851-6178
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Fax | 253-851-6199
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Provider Business Mailing Address
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Address Line | 5800 SOUNDVIEW DR STE 101-D
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City | GIG HARBOR
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State | WA
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Zip | 98335-2077
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Country | US
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Telephone | 253-851-6178
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Fax | 253-851-6199
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Authorized Official
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Title or Position | PRESIDENT AND ONLY EMPLOYEE
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Name | JANEEN PROVAZEK
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Credential | MA
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Telephone | 253-851-6178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00001337
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License Number State | WA
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