1396328365 NPI number — BRINKOPF & YANT PSYCHIATRIC SERVICES, PLLC

Table of content: (NPI 1396328365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396328365 NPI number — BRINKOPF & YANT PSYCHIATRIC SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRINKOPF & YANT PSYCHIATRIC SERVICES, PLLC
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:
6
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:
1396328365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 E MAIN STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-5612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-466-3122
Provider Business Mailing Address Fax Number:
253-256-7911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 E MAIN STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98372-5612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-466-3122
Provider Business Practice Location Address Fax Number:
253-256-7911
Provider Enumeration Date:
04/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BRINKOPF
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-466-3122

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP60989967 . This is a "STATE ARNP LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: LP60921975 . This is a "STATE LPN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: PMHNP-BC . This is a "AMERICAN NURSES CREDENTIALING CENTER (ANCC)" identifier . This identifiers is of the category "OTHER".
  • Identifier: RN60622681 . This is a "STATE RN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: RN60101504 . This is a "STATE RN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP60989620 . This is a "STATE ARNP LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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