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1750254629 NPI number — URBAN REFUGE THERAPY, LLC

NPI Number: 1750254629
Health Care Provider/Practitioner: URBAN REFUGE THERAPY, LLC

Information about “1750254629” NPI (URBAN REFUGE THERAPY, LLC) exists in 1750254629 in HTML format HTML  |  1750254629 in plain Text format TXT  |  1750254629 in PDF (Portable Document Format) PDF  |  1750254629 in an XML format XML  formats.

NPI Number : 1750254629 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750254629",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "URBAN REFUGE THERAPY, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6308 52ND AVE W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "UNIVERSITY PLACE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98467-3711",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-389-6353",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2550 YAKIMA AVE UNIT A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TACOMA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98405-3863",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-389-6353",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/26/2025",
    "LastUpdateDate": "09/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WELLS",
    "AuthorizedOfficialFirstName": "MAIRUT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CLINICAL SOCIAL WORKER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MSW, LSWAIC",
    "AuthorizedOfficialTelephoneNumber": "253-389-6353",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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