Provider Demographics
NPI:1043603905
Name:VIVOMOMENTIS
Entity Type:Organization
Organization Name:VIVOMOMENTIS
Other - Org Name:RELATIONSHIPS, BODIES, AND MINDS BY DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:425-736-7911
Mailing Address - Street 1:13662 99TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-1929
Mailing Address - Country:US
Mailing Address - Phone:425-736-7911
Mailing Address - Fax:
Practice Address - Street 1:9757 NE JUANITA DR
Practice Address - Street 2:SUITE 206
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4299
Practice Address - Country:US
Practice Address - Phone:425-736-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60281317101YA0400X
WALH60492836101YM0800X
WALF60521657106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty