Organization
PUGET SOUND PSYCHIATRIC CENTER, PS
Active
Other names
PSPC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SYED JAMAL MUSTAFA MD (MEDICAL DIRECTOR)
(425) 806-5021
Entity
Organization
Contact information
Practice address
10634 E RIVERSIDE DR, SUITE 130, BOTHELL, WA 98011-3757
(425) 806-5021
(425) 486-3949
Mailing address
10634 E RIVERSIDE DR, SUITE 130, BOTHELL, WA 98011-3758
(425) 806-5021
(425) 486-3949
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
MD00034219
WA
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1112333
—
WA
Enumeration date
11/03/2009
Last updated
01/23/2012
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