| NPI | 1053035105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA OHLSTROM Provider/Sole Owner 206-531-4548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-10-26 |