Provider Demographics
NPI:1043021595
Name:ICARE PSYCHIATRY PLLC
Entity type:Organization
Organization Name:ICARE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-251-7612
Mailing Address - Street 1:19435 68TH AVE S STE S102
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2114
Mailing Address - Country:US
Mailing Address - Phone:253-414-1983
Mailing Address - Fax:425-616-1166
Practice Address - Street 1:19435 68TH AVE S STE S102
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2114
Practice Address - Country:US
Practice Address - Phone:253-414-1983
Practice Address - Fax:425-616-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty