Provider Demographics
NPI:1497168371
Name:PUYALLUP PSYCHOTHERAPEUTIC ALLIANCE
Entity Type:Organization
Organization Name:PUYALLUP PSYCHOTHERAPEUTIC ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANAHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-686-1319
Mailing Address - Street 1:104 W MAIN
Mailing Address - Street 2:202
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-8904
Mailing Address - Country:US
Mailing Address - Phone:253-686-1319
Mailing Address - Fax:
Practice Address - Street 1:104 W MAIN
Practice Address - Street 2:202
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8904
Practice Address - Country:US
Practice Address - Phone:253-686-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHC.LH.60305323251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health