Provider Demographics
NPI:1477116358
Name:TACOMA PSYCHIATRIC CARE, PLLC
Entity Type:Organization
Organization Name:TACOMA PSYCHIATRIC CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, LMHC
Authorized Official - Phone:253-227-1803
Mailing Address - Street 1:PO BOX 7600
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2517 N PROCTOR ST STE 1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5337
Practice Address - Country:US
Practice Address - Phone:253-785-6332
Practice Address - Fax:253-363-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1619152600Medicaid