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General NPI Number Information
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NPI Number | 1912604000
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Entity Type | Organization
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Legal Business Name | VANCOUVER ADHD AND MOOD CLINIC, PLLC
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 10000 NE 7TH AVE STE 410B
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City | VANCOUVER
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State | WA
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Zip | 98685-4599
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Country | US
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Telephone | 360-836-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 NE 7TH AVE STE 410B
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City | VANCOUVER
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State | WA
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Zip | 98685-4599
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Country | US
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Telephone | 360-836-4455
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Fax | 833-553-2040
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TATIANA PRITCHARD
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Credential | ARNP
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Telephone | 865-223-4773
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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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