Provider Demographics
NPI:1992072466
Name:PACIFIC NORTHWEST PSYCHIATRY, PS
Entity type:Organization
Organization Name:PACIFIC NORTHWEST PSYCHIATRY, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HARLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-305-3275
Mailing Address - Street 1:4201 MERIDIAN ST STE 113
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5532
Mailing Address - Country:US
Mailing Address - Phone:360-305-3275
Mailing Address - Fax:360-655-5340
Practice Address - Street 1:1616 CORNWALL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4648
Practice Address - Country:US
Practice Address - Phone:360-305-3275
Practice Address - Fax:360-655-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60205887101Y00000X
WALH00011061101YM0800X
WAMD000397582084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty