Provider Demographics
NPI:1760811475
Name:PSYCHIATRIC SERVICES OF OLYMPIA PLLC
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES OF OLYMPIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDAA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KELLAMS-KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-709-3332
Mailing Address - Street 1:123 18TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2211
Mailing Address - Country:US
Mailing Address - Phone:360-709-3332
Mailing Address - Fax:360-709-3336
Practice Address - Street 1:2114 CATON WAY SW
Practice Address - Street 2:201
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1177
Practice Address - Country:US
Practice Address - Phone:360-709-3332
Practice Address - Fax:360-709-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004049363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty