Organization
HEADSPACE PARKING LOT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRYSTAL G MOORE ARNP (PMHNP)
(757) 323-9104
Entity
Organization
Contact information
Practice address
76 SUND RD, ELMA, WA 98541-9119
(360) 929-0022
Mailing address
76 SUND RD, ELMA, WA 98541-9119
(360) 929-0022
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/01/2023
Last updated
11/01/2024
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