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General NPI Number Information
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NPI Number | 1902779796
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Entity Type | Organization
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Legal Business Name | DOMAIN PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 819 N 49TH ST STE 302
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City | SEATTLE
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State | WA
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Zip | 98103-6577
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Country | US
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Telephone | 206-208-8957
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 257 PMB 11130
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City | OLYMPIA
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State | WA
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Zip | 98507-0257
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Country | US
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Telephone | 206-208-8957
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW CLARK
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Credential |
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Telephone | 206-208-8957
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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 |
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License Number State |
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