| NPI | 1134886153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ERIN MARCELLO Provider/Owner 360-550-9745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-11-24 |
| Last Update Date | 2021-11-24 |