| Brawta Psychiatric Care Pllc | |
|
16404 Smokey Point Blvd Ste 103b Arlington WA 98223-8417 | |
| (425) 404-1616 | |
| Not Available |
| Full Name | Brawta Psychiatric Care Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 16404 Smokey Point Blvd Ste 103b, Arlington, Washington |
| Authorized Official Name and Position | Mosiah Alphanso Wilson (OWNER) |
| Authorized Official Contact | 4254041616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brawta Psychiatric Care Pllc 27402 Church Creek Loop Nw Stanwood WA 98292-9597 Ph: () - | Brawta Psychiatric Care Pllc 16404 Smokey Point Blvd Ste 103b Arlington WA 98223-8417 Ph: (425) 404-1616 |
| NPI Number | 1770304271 |
|---|---|
| Provider Enumeration Date | 10/18/2024 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/30/2024 |
| Medicare PECOS PAC ID | 0840728432 |
|---|---|
| Medicare Enrollment ID | O20250109003313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770304271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mosiah Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700412525 PECOS PAC ID: 8325406929 Enrollment ID: I20230928003168 |
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