Provider Demographics
NPI:1053545343
Name:PROACTIVE PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:PROACTIVE PSYCHIATRIC SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-869-3266
Mailing Address - Street 1:400 S JEFFERSON ST STE 163
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3143
Mailing Address - Country:US
Mailing Address - Phone:509-456-5733
Mailing Address - Fax:509-327-5191
Practice Address - Street 1:400 S JEFFERSON ST STE 163
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3143
Practice Address - Country:US
Practice Address - Phone:509-456-5733
Practice Address - Fax:509-327-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB0295837OtherDEA
G8862521Medicare PIN
G8862520Medicare PIN
545353Medicare UPIN