# KETAMINE WELLNESS CENTERS WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KETAMINE WELLNESS CENTERS ARIZONA LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457918831
- **Legal business name:** KETAMINE WELLNESS CENTERS ARIZONA LLC
- **Authorized official:** ANITA D JERGER (EXECUTIVE ASSISTANT)
- **Authorized official phone:** (855) 538-9355

## Contact information

- **Practice address:** 34709 9TH AVE S STE B200, FEDERAL WAY, WA 98003-8724
- **Practice address phone:** (855) 538-9355
- **Practice address fax:** (844) 538-9355
- **Mailing address:** 34709 9TH AVE S STE B200, FEDERAL WAY, WA 98003-8724
- **Mailing address phone:** (855) 538-9355
- **Mailing address fax:** (844) 538-9355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 05/21/2019
- **Last updated:** 12/21/2020