Provider Demographics
NPI:1639977002
Name:PACIFIC NORTHWEST MENTAL WELLNESS LLC
Entity type:Organization
Organization Name:PACIFIC NORTHWEST MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEANEY RULE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:253-765-8325
Mailing Address - Street 1:17837 1ST AVE S # 203
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1728
Mailing Address - Country:US
Mailing Address - Phone:253-765-8325
Mailing Address - Fax:
Practice Address - Street 1:18610 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98166-4010
Practice Address - Country:US
Practice Address - Phone:206-291-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty