Provider Demographics
NPI:1801380191
Name:NORTHWEST INTEGRATIVE PSYCHOTHERAPY, INC. P.S.
Entity Type:Organization
Organization Name:NORTHWEST INTEGRATIVE PSYCHOTHERAPY, INC. P.S.
Other - Org Name:OTHER NAME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-324-3581
Mailing Address - Street 1:3245 FAIRVIEW AVE E STE 310
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3053
Mailing Address - Country:US
Mailing Address - Phone:206-324-3581
Mailing Address - Fax:866-602-1865
Practice Address - Street 1:3245 FAIRVIEW AVE E STE 310
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-324-3581
Practice Address - Fax:866-602-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1785103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty