Provider Demographics
NPI:1639438955
Name:PREMIER THERAPEUTIC EXPERIENCE
Entity Type:Organization
Organization Name:PREMIER THERAPEUTIC EXPERIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOGSDILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CDPT
Authorized Official - Phone:253-970-0779
Mailing Address - Street 1:8105 166TH AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3999
Mailing Address - Country:US
Mailing Address - Phone:253-970-0779
Mailing Address - Fax:
Practice Address - Street 1:8105 166TH AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3999
Practice Address - Country:US
Practice Address - Phone:253-970-0779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60270904305R00000X
WACO 60180142305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization