Organization
KETAMINE WELLNESS CENTERS WASHINGTON
Active
Parent organization
KETAMINE WELLNESS CENTERS ARIZONA LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KETAMINE WELLNESS CENTERS ARIZONA LLC
Authorized official
ANITA D JERGER (EXECUTIVE ASSISTANT)
(855) 538-9355
Entity
Organization
Contact information
Practice address
34709 9TH AVE S STE B200, FEDERAL WAY, WA 98003-8724
(855) 538-9355
(844) 538-9355
Mailing address
34709 9TH AVE S STE B200, FEDERAL WAY, WA 98003-8724
(855) 538-9355
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
05/21/2019
Last updated
12/21/2020
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