Provider Demographics
NPI:1447618053
Name:LLC COURAGE 2B
Entity Type:Organization
Organization Name:LLC COURAGE 2B
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:253-363-2244
Mailing Address - Street 1:920 ALDER AVE
Mailing Address - Street 2:STE.207
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1401
Mailing Address - Country:US
Mailing Address - Phone:253-363-2244
Mailing Address - Fax:253-883-3535
Practice Address - Street 1:1764 N JAMES ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-1508
Practice Address - Country:US
Practice Address - Phone:253-208-7644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60477833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty