Provider Demographics
NPI:1235986092
Name:EXECUTIVE PSYCHIATRY GROUP PLLC
Entity type:Organization
Organization Name:EXECUTIVE PSYCHIATRY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMORIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-626-2419
Mailing Address - Street 1:100 N HOWARD ST # 5667
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:425-626-2419
Mailing Address - Fax:
Practice Address - Street 1:6029 122ND PL SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5578
Practice Address - Country:US
Practice Address - Phone:818-568-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty