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TERESA BLACK M.D. INC. PS.

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Company Details

Legal Name: TERESA BLACK M.D. INC. PS.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: December 26th 2005
Date of Dissolution: April 1st 2013
Expiration date: 31 Dec 2012
UBI Number: 602 569 620
ZIP code: 98225
City: Bellingham
County: WHATCOM
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 12 BELLWETHER WAY STE 223, BELLINGHAM, WA, 98225, UNITED STATES

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Registered Agent Information

Name Role Address
TERESA BLACK Registered Agent 12 BELLWETHER WAY STE 223, BELLINGHAM, WA, 98225, UNITED STATES

Key Officers & Management

Name Role
RICHARD BLACK Governing Person
TERESA BLACK Governing Person

National Provider Identifier

NPI Number:
1053322941

Authorized Person:

Name:
TERESA BLACK
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

Fax:
3602552504
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