| |
9116 Gravelly Lake Dr Sw Ste 102 Lakewood WA 98499-3148 | |
(253) 200-5763 | |
(253) 590-4298 |
Full Name | |
---|---|
Speciality | Psychiatry & Neurology |
Location | 9116 Gravelly Lake Dr Sw Ste 102, Lakewood, Washington |
Authorized Official Name and Position | Tasha Morris (MEDICAL DIRECTOR) |
Authorized Official Contact | 4252562967 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
9116 Gravelly Lake Dr Sw Ste 102 Lakewood WA 98499-3148 Ph: (253) 200-5764 | 9116 Gravelly Lake Dr Sw Ste 102 Lakewood WA 98499-3148 Ph: (253) 200-5763 |
NPI Number | 1710415617 |
---|---|
Provider Enumeration Date | 05/23/2017 |
Last Update Date | 09/20/2023 |
Certification Date | 09/20/2023 |
Medicare PECOS PAC ID | 1557761608 |
---|---|
Medicare Enrollment ID | O20210611001322 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710415617 | NPI | - | NPPES |
Provider Name | Ioana Diaconu |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1679515142 PECOS PAC ID: 1951374420 Enrollment ID: I20040813000948 |
Provider Name | Jessica J Jajesnica |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780779827 PECOS PAC ID: 9931273638 Enrollment ID: I20080729000592 |
Provider Name | Rita Ann Kostelik |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003009135 PECOS PAC ID: 6507927100 Enrollment ID: I20081201000479 |
Provider Name | Tasha Elisa Morris |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1700957115 PECOS PAC ID: 8426082520 Enrollment ID: I20090909000487 |
Provider Name | Amy O Zachara |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124337969 PECOS PAC ID: 0446447882 Enrollment ID: I20101210000066 |
Provider Name | Nicholas T Weiss |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1609049071 PECOS PAC ID: 6305861691 Enrollment ID: I20120105000508 |
Provider Name | Meghan L O'neil |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1154333094 PECOS PAC ID: 6901072107 Enrollment ID: I20120109000977 |
Provider Name | Power Capote |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134578834 PECOS PAC ID: 1254616345 Enrollment ID: I20170403001475 |
Provider Name | Dawn Michele Mason |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033685169 PECOS PAC ID: 2163320359 Enrollment ID: I20190205003602 |
Provider Name | Courtney Yant |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073173977 PECOS PAC ID: 6103157003 Enrollment ID: I20191008000019 |
Provider Name | Tracie Lynne Ross |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669016093 PECOS PAC ID: 9830528728 Enrollment ID: I20200327001458 |
Provider Name | Christopher J Sheets |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1629629597 PECOS PAC ID: 4981027877 Enrollment ID: I20200720001423 |
Provider Name | Megan Marie Foster |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528641016 PECOS PAC ID: 9335544600 Enrollment ID: I20210825000460 |
Provider Name | Matthew Kilgore |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447743117 PECOS PAC ID: 9739533456 Enrollment ID: I20230929000985 |
Provider Name | Brooke Marino |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1588447452 PECOS PAC ID: 5597111674 Enrollment ID: I20241003004001 |
Paul Kenneth Henry Med Lmhc Ps Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9101 Bridgeport Way Sw Ste D2, Lakewood, WA 98499 Phone: 253-394-6045 | |
Lakewood Wellness Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10310 Gravelly Lake Dr Sw Ste B, Lakewood, WA 98499 Phone: 253-888-3405 | |