Provider Demographics
NPI:1427715325
Name:SPRUCE PSYCHIATRIC
Entity type:Organization
Organization Name:SPRUCE PSYCHIATRIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-486-1500
Mailing Address - Street 1:2817 NE 55TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5536
Mailing Address - Country:US
Mailing Address - Phone:206-486-1500
Mailing Address - Fax:206-775-7215
Practice Address - Street 1:2817 NE 55TH ST STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5536
Practice Address - Country:US
Practice Address - Phone:206-486-1500
Practice Address - Fax:206-775-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty