Glacier Lake Wellness PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

GLACIER LAKE WELLNESS PLLC

Practice address

1400 112TH Ave SE Ste 100
Bellevue, WA 98004-6901

Phone

(541) 623-0738

NPI assigned

Nov 7, 2019

Last updated

Jul 19, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas MooreNPI 1538598487

Title

President

Phone

(541) 345-1722

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Moore, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Eugene, OR
  • NPI 1538598487
  Authorized official Same address or phone

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

{
    "created_epoch": "1573084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658188800000",
    "number": "1699310284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 N SANGAMON ST STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072201",
            "telephone_number": "309-397-2415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 112TH AVE SE STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046901",
            "telephone_number": "541-623-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER LAKE WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-07",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-345-1722"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Girnus, M.A., AAC
• Peggy M Gironde
• Pamela Girres, M.D.
• Patti Gitaka, LMP
• Stacey Giuffre
• Savannah Glasgow, RDN
• Laurel Noelle Glassley
• Barry Mark Glatt, LMHC
• Sara Ann Glatz, L.M.P.
• Robert V Glaze, OD

• Psychiatric/Mental Health Nurse Practitioner in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; 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.