NPIMap

Organization Active NPI

Katie's Way Tacoma, LLC

Doing business as Katies Way

  • Behavioral Neurology & Neuropsychiatry Physician
  • Tacoma, WA
National Provider Identifier
1285405522
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
Legal business name
KATIE'S WAY TACOMA, LLC
Doing business as
Katies Way
Practice address
6704 Tacoma Mall Blvd Ste 111
Tacoma, WA 98409-9001
Phone
(253) 260-3460
Fax
(253) 397-3443
NPI assigned
Jan 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Kelly Rae Johnson
Title
Credentialing Director
Phone
(785) 320-6616

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Prescribing (Medical) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP0016X
Psychoanalysis PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP0814X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Integrative Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 202D00000X
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084B0040X Primary
Psychosomatic Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0015X

Addresses

Primary practice location

6704 Tacoma Mall Blvd Ste 111
Tacoma, WA 98409-9001

Mailing address

6704 Tacoma Mall Blvd Ste 111
Tacoma, WA 98409-9001
Phone (253) 260-3460

Other practice location 1

1175 Central Drive
Suite 130
Dupoint, WA 98327
Phone (253) 260-6521

Other names 1

  • KATIES WAY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250212003560 WA Part B Supplier - Clinic/Group Practice 4688104136 Receives reassigned benefits from 2 practitioners
Practice locations: Tacoma, WA

National Provider Directory

National Provider Directory
Tax ID family
Katies Way Tacoma LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6704 Tacoma Mall Blvd
Ste 111
Tacoma, WA 98409
Phone (253) 260-3460

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1705276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1285405522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6704 TACOMA MALL BLVD STE 111",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984099001",
            "telephone_number": "253-260-3460",
            "fax_number": "253-397-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6704 TACOMA MALL BLVD STE 111",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984099001",
            "telephone_number": "253-260-3460",
            "fax_number": "253-397-3443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1175 CENTRAL DRIVE",
            "address_2": "SUITE 130",
            "address_purpose": "LOCATION",
            "city": "DUPOINT",
            "state": "WA",
            "postal_code": "98327",
            "country_code": "US",
            "telephone_number": "253-260-6521",
            "fax_number": "253-397-3443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KATIE'S WAY TACOMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-15",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "CREDENTIALING  DIRECTOR",
        "authorized_official_telephone_number": "785-320-6616"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0015X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KATIES WAY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KATIES WAY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.