Provider Demographics
NPI:1376340430
Name:PSYCHED UP SUCCESS LLC
Entity type:Organization
Organization Name:PSYCHED UP SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CHT
Authorized Official - Phone:425-608-1867
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:CONCRETE
Mailing Address - State:WA
Mailing Address - Zip Code:98237-0247
Mailing Address - Country:US
Mailing Address - Phone:425-608-1867
Mailing Address - Fax:425-845-2375
Practice Address - Street 1:7558 PRESSENTIN RANCH DR
Practice Address - Street 2:
Practice Address - City:CONCRETE
Practice Address - State:WA
Practice Address - Zip Code:98237-8803
Practice Address - Country:US
Practice Address - Phone:425-608-1867
Practice Address - Fax:425-845-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health