Basic Information
| Provider Information | |||||||||
| NPI: | 1841714276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHIATRIC SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 N MAMER RD BLDG B, SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992163722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308993150 | ||||||||
| FaxNumber: | 5308093926 | ||||||||
| Practice Location | |||||||||
| Address1: | 1620 N MAMER RD BLDG B | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992163722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308993150 | ||||||||
| FaxNumber: | 5308093926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ABOUESH | ||||||||
| AuthorizedOfficialFirstName: | ABOUESH | ||||||||
| AuthorizedOfficialMiddleName: | IBRAHIM | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5308993150 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.