Provider Demographics
NPI:1134574569
Name:OLYMPIC PSYCHIATRIC CARE PS
Entity type:Organization
Organization Name:OLYMPIC PSYCHIATRIC CARE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GODBY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-683-2344
Mailing Address - Street 1:502 S STILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3577
Mailing Address - Country:US
Mailing Address - Phone:360-683-2344
Mailing Address - Fax:360-504-3666
Practice Address - Street 1:502 S STILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3577
Practice Address - Country:US
Practice Address - Phone:360-683-2344
Practice Address - Fax:360-504-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60528556261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)