| Decide Differently, Llc | |
|
271 Madison Ave S Ste 203 Bainbridge Island WA 98110-2524 | |
| (206) 486-4338 | |
| Not Available |
| Full Name | Decide Differently, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 271 Madison Ave S Ste 203, Bainbridge Island, Washington |
| Authorized Official Name and Position | Shakti Sutriasa (PSYCHOTHERAPSIT) |
| Authorized Official Contact | 2064864338 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Decide Differently, Llc Po Box 4467 Rollingbay WA 98061-0467 Ph: (206) 486-4338 | Decide Differently, Llc 271 Madison Ave S Ste 203 Bainbridge Island WA 98110-2524 Ph: (206) 486-4338 |
| NPI Number | 1033548805 |
|---|---|
| Provider Enumeration Date | 11/02/2013 |
| Last Update Date | 12/23/2022 |
| Certification Date | 12/23/2022 |
| Medicare PECOS PAC ID | 4587891841 |
|---|---|
| Medicare Enrollment ID | O20131211001185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033548805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW 11579 (Florida) | Primary |
| Provider Name | Shakti G Sutriasa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750660841 PECOS PAC ID: 2961639232 Enrollment ID: I20131211001423 |
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