Provider Demographics
NPI:1134886153
Name:ALAYA INTEGRATIVE MENTAL HEALTHCARE, LLC
Entity type:Organization
Organization Name:ALAYA INTEGRATIVE MENTAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:MARCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-550-9745
Mailing Address - Street 1:15640 NE FOURTH PLAIN BLVD
Mailing Address - Street 2:STE 106, #440
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682
Mailing Address - Country:US
Mailing Address - Phone:360-550-9745
Mailing Address - Fax:364-888-3877
Practice Address - Street 1:15640 NE FOURTH PLAIN BLVD
Practice Address - Street 2:STE 106, #440
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682
Practice Address - Country:US
Practice Address - Phone:360-550-9745
Practice Address - Fax:364-888-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty