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General NPI Number Information
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NPI Number | 1902441751
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Entity Type | Organization
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Legal Business Name | PACIFIC WELLNESS PARTNERS (PWP) PLLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 5400 CARILLON PT BLDG 50004TH
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City | KIRKLAND
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State | WA
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Zip | 98033-7357
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Country | US
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Telephone | 818-635-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 2022 210TH CIR NE
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City | SAMMAMISH
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State | WA
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Zip | 98074-4210
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Country | US
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Telephone | 818-635-4337
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OWNER
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Name | DR. SHADI SHIRAZI
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Credential | PSYD
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Telephone | 818-635-4337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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