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SPRUCE PSYCHIATRIC, PLLC

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Company Details

Legal Name: SPRUCE PSYCHIATRIC, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: April 19th 2021
Expiration date: 30 Apr 2026
UBI Number: 604 748 206
ZIP code: 98107
City: Seattle
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 126 NW CANAL ST STE 200, SEATTLE, WA, 98107-4970, UNITED STATES

Contact Details

E-Mail: MANAGER@SPRUCEPSYCHIATRIC.COM

Nature of Business

Health Care, Social Assistance & Service Organization, Professional, Scientific & Technical Services

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Registered Agent Information

Name Role Address
GAVIN BRINK Registered Agent 126 NW CANAL ST STE 200, SEATTLE, WA, 98107-4970, UNITED STATES

Key Officers & Management

Name Role Address
ELIZA BRINK Executor 102 N 51ST ST, SEATTLE, WA, 98103-6005, UNITED STATES
GAVIN BRINK Executor 102 N 51ST ST, SEATTLE, WA, 98103-6005, UNITED STATES
ELIZA BRINK Governing Person -

National Provider Identifier

NPI Number:
1427715325
Certification Date:
2022-07-08

Authorized Person:

Name:
GAVIN BRINK
Role:
PRACTICE MANAGER
Phone:

Taxonomy:

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

Contacts:

Fax:
2067757215

Form 5500 Series

Employer Identification Number (EIN):
873723808
Plan Year:
2023
Number Of Participants:
2
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
GAVIN BRINK(Plan administrator)
Plan Year:
2022
Number Of Participants:
1
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
GAVIN BRINK(Plan administrator)
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