Provider Demographics
NPI:1245462134
Name:CRESCENT PSYCHIATRY PLLC
Entity type:Organization
Organization Name:CRESCENT PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:VARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-514-8076
Mailing Address - Street 1:7191 WAGNER WAY NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6909
Mailing Address - Country:US
Mailing Address - Phone:253-514-8076
Mailing Address - Fax:253-514-8078
Practice Address - Street 1:3819 100TH ST SW
Practice Address - Street 2:SUITE 7-C
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4470
Practice Address - Country:US
Practice Address - Phone:253-588-7911
Practice Address - Fax:253-984-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030816103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0243791OtherLABOR & INDUSTRIES