Provider Demographics
NPI:1639826837
Name:EMERALD ISLE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:EMERALD ISLE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-204-8510
Mailing Address - Street 1:4301 S PINE ST STE 17
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7252
Mailing Address - Country:US
Mailing Address - Phone:720-204-8510
Mailing Address - Fax:720-828-6114
Practice Address - Street 1:4301 S PINE ST STE 17
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7252
Practice Address - Country:US
Practice Address - Phone:720-204-8510
Practice Address - Fax:720-828-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty