1396001749 NPI number — SPOKANE THERAPIST LLC

Table of content: (NPI 1396001749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396001749 NPI number — SPOKANE THERAPIST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPOKANE THERAPIST LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396001749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 N WASHINGTON ST
Provider Second Line Business Mailing Address:
206
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99201-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-209-9486
Provider Business Mailing Address Fax Number:
509-232-0883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
206
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-209-9486
Provider Business Practice Location Address Fax Number:
509-232-0883
Provider Enumeration Date:
04/10/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STOOPS
Authorized Official First Name:
LAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
50920299486

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MC60115047 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)