MEDICARE: PORT TOWNSEND PSYCHIATRIC MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1467016444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT TOWNSEND PSYCHIATRIC MEDICINE

Provider Business Mailing Address
First Line	:	1136 WATER ST STE 106
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6728
Country	:	US
Telephone Number	:	360-385-9818
Fax Number	:	360-385-1496

Provider Business Practice Location Address
First Line	:	210 POLK ST STE 4A
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6739
Country	:	US
Telephone Number	:	360-385-9818
Fax Number	:	360-385-1496

Authorized Official
Title or Position	:	OWNER/PSYCHIATRIST
Name	:	DR. KARI CASE HEISTAND
Credential	:	M.D.
Telephone Number	:	360-385-9818

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/29/2021

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