Provider Demographics
NPI:1154942142
Name:PRISMA WELLNESS LLC
Entity type:Organization
Organization Name:PRISMA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-785-1015
Mailing Address - Street 1:321 BURNETT AVE S FL 2
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2558
Mailing Address - Country:US
Mailing Address - Phone:206-785-1015
Mailing Address - Fax:206-785-1023
Practice Address - Street 1:3705 SE CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1704
Practice Address - Country:US
Practice Address - Phone:206-785-1015
Practice Address - Fax:206-785-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty