Provider Demographics
NPI:1467016444
Name:PORT TOWNSEND PSYCHIATRIC MEDICINE
Entity type:Organization
Organization Name:PORT TOWNSEND PSYCHIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:CASE
Authorized Official - Last Name:HEISTAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-385-9818
Mailing Address - Street 1:1136 WATER ST STE 106
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6728
Mailing Address - Country:US
Mailing Address - Phone:360-385-9818
Mailing Address - Fax:360-385-1496
Practice Address - Street 1:210 POLK ST STE 4A
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6739
Practice Address - Country:US
Practice Address - Phone:360-385-9818
Practice Address - Fax:360-385-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)