Pacific Psychiatric Consulting PLLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

MD00047610 Issued in WA

Legal business name

PACIFIC PSYCHIATRIC CONSULTING PLLC

Practice address

24001 56TH Ave W
Suite D404
Mountlake Terrace, WA 98043-5558

Phone

(425) 749-5008

Fax

(866) 305-0497

NPI assigned

Jul 22, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Supriya Kang, MD

Title

Owner / Sole Proprietor

Phone

(425) 749-5008

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1033374749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24001 56TH AVE W",
            "address_2": "SUITE D404",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980435558",
            "telephone_number": "425-749-5008",
            "fax_number": "866-305-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24001 56TH AVE W",
            "address_2": "SUITE D404",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980435558",
            "telephone_number": "425-749-5008",
            "fax_number": "866-305-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC PSYCHIATRIC CONSULTING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "KANG",
        "authorized_official_first_name": "SUPRIYA",
        "authorized_official_title_or_position": "OWNER / SOLE PROPRIETOR",
        "authorized_official_telephone_number": "425-749-5008",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "WA",
            "license": "MD00047610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Adult Mental Health Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.