Provider Demographics
NPI:1609601384
Name:PSYCHE WELLBEING
Entity type:Organization
Organization Name:PSYCHE WELLBEING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROQUEZA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:360-903-1829
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-0699
Mailing Address - Country:US
Mailing Address - Phone:360-903-1829
Mailing Address - Fax:360-991-0337
Practice Address - Street 1:201 NE PARK PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5871
Practice Address - Country:US
Practice Address - Phone:360-903-1829
Practice Address - Fax:360-991-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1598019697OtherPROVIDER'S NPI (PRESIDENT/OWNER OF PSYCHE WELLBEING)