| Psyched For Life Llc | |
|
713 S Alder Ln Port Angeles WA 98362-8462 | |
| (136) 058-2790 | |
| Not Available |
| Full Name | Psyched For Life Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 713 S Alder Ln, Port Angeles, Washington |
| Authorized Official Name and Position | Stephanie Marie Diltz (OWNER/THERAPIST) |
| Authorized Official Contact | 3605827908 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psyched For Life Llc 713 S Alder Ln Port Angeles WA 98362-8462 Ph: (136) 058-2790 | Psyched For Life Llc 713 S Alder Ln Port Angeles WA 98362-8462 Ph: (136) 058-2790 |
| NPI Number | 1326637778 |
|---|---|
| Provider Enumeration Date | 01/11/2021 |
| Last Update Date | 01/11/2021 |
| Certification Date | 01/11/2021 |
| Medicare PECOS PAC ID | 4789099862 |
|---|---|
| Medicare Enrollment ID | O20210223002540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326637778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Stephanie Marie Diltz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730491424 PECOS PAC ID: 3779917679 Enrollment ID: I20191231002081 |
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