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General NPI Number Information
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NPI Number | 1750528444
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Entity Type | Organization
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Legal Business Name | OLYMPIC PSYCHIATRIC & WELLNESS CENTER
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 2528 WHEATON WAY STE 106
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City | BREMERTON
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State | WA
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Zip | 98310-3305
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Country | US
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Telephone | 360-782-0114
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Fax |
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Provider Business Mailing Address
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Address Line | 2528 WHEATON WAY STE 106
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City | BREMERTON
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State | WA
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Zip | 98310-3305
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Country | US
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Telephone | 360-782-0114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRILYNN NICKLIN GRISWOLD
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Credential |
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Telephone | 360-782-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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