Provider Demographics
NPI:1902441751
Name:PACIFIC WELLNESS PARTNERS (PWP) PLLC
Entity Type:Organization
Organization Name:PACIFIC WELLNESS PARTNERS (PWP) PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-635-4337
Mailing Address - Street 1:2022 210TH CIR NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4210
Mailing Address - Country:US
Mailing Address - Phone:818-635-4337
Mailing Address - Fax:
Practice Address - Street 1:5400 CARILLON PT BLDG 50004TH
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7357
Practice Address - Country:US
Practice Address - Phone:818-635-4337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty