1306308556 NPI number — NORTHWEST HOLISTIC THERAPIES, P.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306308556 NPI number — NORTHWEST HOLISTIC THERAPIES, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST HOLISTIC THERAPIES, P.S.
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:
NORTHWEST HOLISTIC THERAPIES, P.S.
Provider Other Organization Name Type Code:
5
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:
1306308556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18024 49TH PL W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98037-5400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-418-2949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19125 N CREEK PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011-8035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-375-0432
Provider Business Practice Location Address Fax Number:
425-740-0516
Provider Enumeration Date:
04/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SPRAGUE
Authorized Official First Name:
MAYA
Authorized Official Middle Name:
SOPHIA
Authorized Official Title or Position:
OWNER & CLINICAL DIRECTOR
Authorized Official Telephone Number:
425-375-0432

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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