Provider Demographics
NPI:1477237618
Name:LIVE WELL PSYCHIATRY
Entity Type:Organization
Organization Name:LIVE WELL PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LAMIGO
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-245-8668
Mailing Address - Street 1:3005 13TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-3896
Mailing Address - Country:US
Mailing Address - Phone:125-324-5866
Mailing Address - Fax:
Practice Address - Street 1:3005 13TH AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-3896
Practice Address - Country:US
Practice Address - Phone:125-324-5866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit