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DEEP INSIGHT PLLC

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Company Details

Legal Name: DEEP INSIGHT PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: June 28th 2023
Expiration date: 30 Jun 2026
UBI Number: 605 284 457
Home State: OREGON
Principal Office Street Address: Google Maps Logo 6400 SE LAKE RD STE 135, PORTLAND, OR, 97222-2189, UNITED STATES

Contact Details

E-Mail: CORPORATE@OMWLAW.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
LESLIE R. PESTERFIELD Registered Agent 701 5TH AVE STE 5600, SEATTLE, WA, 98104-7045, UNITED STATES

Key Officers & Management

Name Role Address
JILL CARTER Governing Person -
SHAWN DEREMER Governing Person -
JILL CARTER FNP EXECUTOR 6400 SE LAKE RD STE 135, PORTLAND, OR, 97222-2189, UNITED STATES

National Provider Identifier

NPI Number:
1770357964
Certification Date:
2023-12-04

Authorized Person:

Name:
AMY DAWN MOORE
Role:
REGIONAL CONTRACTING DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
5039174971
Fax:
8888505616
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