Provider Demographics
NPI:1124852090
Name:NEW CHAPTER TMS LLC
Entity type:Organization
Organization Name:NEW CHAPTER TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIIRA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:TIETJEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP ARNP PMHNP
Authorized Official - Phone:509-953-6381
Mailing Address - Street 1:20006 E KNOX CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9222
Mailing Address - Country:US
Mailing Address - Phone:509-953-6381
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST STE 506
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2260
Practice Address - Country:US
Practice Address - Phone:509-934-0245
Practice Address - Fax:612-439-7181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-31
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366992091OtherTYPE 1 NPI
WA2300892Medicaid
1265871578OtherTYPE 1 NPI