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General NPI Number Information
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NPI Number | 1962883538
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Entity Type | Organization
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Legal Business Name | VIVANTE THERAPY
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 2606 1/2 3RD AVE
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City | SEATTLE
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State | WA
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Zip | 98121-1214
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Country | US
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Telephone | 541-203-3525
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Fax |
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Provider Business Mailing Address
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Address Line | 2606 1/2 3RD AVE
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City | SEATTLE
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State | WA
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Zip | 98121-1214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MRS. JESSICA RUBINSTEIN
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Credential | LMFT
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Telephone | 541-203-3525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LF60529888
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License Number State | WA
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