Provider Demographics
NPI:1316675754
Name:MOVIN BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:MOVIN BEHAVIORAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADUOBI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:360-821-4302
Mailing Address - Street 1:14205 SE 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1553
Mailing Address - Country:US
Mailing Address - Phone:832-713-9170
Mailing Address - Fax:
Practice Address - Street 1:14205 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1596
Practice Address - Country:US
Practice Address - Phone:360-821-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2206630Medicaid