Provider Demographics
NPI:1396468567
Name:PUGET SOUND EXPRESSIVE ARTS THERAPY, PLLC
Entity type:Organization
Organization Name:PUGET SOUND EXPRESSIVE ARTS THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PARIDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:541-350-8489
Mailing Address - Street 1:5450 CALIFORNIA AVE SW STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1577
Mailing Address - Country:US
Mailing Address - Phone:206-452-7442
Mailing Address - Fax:206-452-7442
Practice Address - Street 1:5450 CALIFORNIA AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1577
Practice Address - Country:US
Practice Address - Phone:206-452-7442
Practice Address - Fax:206-452-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty