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General NPI Number Information
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NPI Number | 1679286918
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Entity Type | Organization
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Legal Business Name | ACCESS HOLISTIC CARE PLLC
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 4007 BRIDGEPORT WAY W STE B
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4330
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Country | US
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Telephone | 253-234-4199
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Fax | 206-594-6141
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Provider Business Mailing Address
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Address Line | PO BOX 65512
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City | TACOMA
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State | WA
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Zip | 98464-1512
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Country | US
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Telephone | 253-234-4199
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Fax | 206-594-6141
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Authorized Official
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Title or Position | PMHNP
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Name | AYUB MWAURA
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Credential | PMHNP
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Telephone | 919-810-4436
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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