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General NPI Number Information
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NPI Number | 1710477807
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC SERVICES AND MEDICATION MANAGEMENT INC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 12615 E MISSION AVE STE 310
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-1047
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Country | US
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Telephone | 509-707-8581
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Fax |
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Provider Business Mailing Address
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Address Line | 12615 E MISSION AVE STE 310
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-1047
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Country | US
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Telephone | 509-707-8581
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | MR. FRED M ITVELDT
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Credential | ARNP
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Telephone | 509-707-8581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60451837
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License Number State | WA
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