| Live Well Psychiatry | |
|
3005 13th Avenue Ct Nw Puyallup WA 98371-3896 | |
| (125) 324-5866 | |
| Not Available |
| Full Name | Live Well Psychiatry |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 3005 13th Avenue Ct Nw, Puyallup, Washington |
| Authorized Official Name and Position | Stephanie Lamigo Brooks (OWNER) |
| Authorized Official Contact | 2532458668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Psychiatry 3005 13th Avenue Ct Nw Puyallup WA 98371-3896 Ph: (125) 324-5866 | Live Well Psychiatry 3005 13th Avenue Ct Nw Puyallup WA 98371-3896 Ph: (125) 324-5866 |
| NPI Number | 1477237618 |
|---|---|
| Provider Enumeration Date | 06/08/2023 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/08/2023 |
| Medicare PECOS PAC ID | 5799148847 |
|---|---|
| Medicare Enrollment ID | O20230823001039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477237618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
| Provider Name | Stephanie Lamigo Brooks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811410657 PECOS PAC ID: 7113321266 Enrollment ID: I20210811002068 |
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