| Marissa Ohlstrom, Psyd, Pllc | |
|
4860 Rainier Avenue S Ste C Seattle WA 98118 | |
| (206) 531-4548 | |
| Not Available |
| Full Name | Marissa Ohlstrom, Psyd, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 4860 Rainier Avenue S Ste C, Seattle, Washington |
| Authorized Official Name and Position | Marissa Ohlstrom (PROVIDER/SOLE OWNER) |
| Authorized Official Contact | 2065314548 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marissa Ohlstrom, Psyd, Pllc 3518 Fremont Ave N # 325 Seattle WA 98103-8814 Ph: (206) 531-4548 | Marissa Ohlstrom, Psyd, Pllc 4860 Rainier Avenue S Ste C Seattle WA 98118 Ph: (206) 531-4548 |
| NPI Number | 1053035105 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Medicare PECOS PAC ID | 6305216029 |
|---|---|
| Medicare Enrollment ID | O20221221001266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053035105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| Provider Name | Marissa Ohlstrom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043775737 PECOS PAC ID: 6608293899 Enrollment ID: I20200902002500 |
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