Provider Demographics
NPI:1952852972
Name:THE PSYCH SPOT
Entity Type:Organization
Organization Name:THE PSYCH SPOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROOKSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-778-6529
Mailing Address - Street 1:15406 MERIDIAN AVENUE E
Mailing Address - Street 2:STE 208
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375
Mailing Address - Country:US
Mailing Address - Phone:253-778-6529
Mailing Address - Fax:
Practice Address - Street 1:15406 MERIDIAN E
Practice Address - Street 2:STE 208
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9504
Practice Address - Country:US
Practice Address - Phone:253-778-6529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health