Organization Name: | PUGET MENTAL CARE LLC |
NPI Number: | 1215334982 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT KOPEC (PSYCHIATRIC NURSE PRACTITIONER) |
Mailing Address: | 4009 Bridgeport Way W # 1a University Place |
State: | WA US |
Postal Code: | 984664326 |
Phone Number: | 2535036761 |
Fax Number: | |
NPI Enumeration Date: | 11/24/2014 |
NPI Last Update Date: | 11/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | AP60411730 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |