=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770304271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAWTA PSYCHIATRIC CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2024
-----------------------------------------------------
Last Update Date | 09/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16404 SMOKEY POINT BLVD STE 103B
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-404-1616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27402 CHURCH CREEK LOOP NW
-----------------------------------------------------
City | STANWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98292-9597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOSIAH ALPHANSO WILSON
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 425-404-1616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------