Provider Demographics
NPI:1497174874
Name:REMIND MENTAL HEALTH RECOVERY CLINIC LLC
Entity Type:Organization
Organization Name:REMIND MENTAL HEALTH RECOVERY CLINIC LLC
Other - Org Name:REMIND LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CORSO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-871-2771
Mailing Address - Street 1:8300 21ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3528
Mailing Address - Country:US
Mailing Address - Phone:253-693-8559
Mailing Address - Fax:
Practice Address - Street 1:8300 21ST AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3528
Practice Address - Country:US
Practice Address - Phone:253-693-8559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60252351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty