Washington State Psychological Services, Llc | |
5105 200th St Sw Ste 100 Lynnwood WA 98036-6397 | |
(425) 387-6972 | |
(425) 377-0701 |
Full Name | Washington State Psychological Services, Llc |
---|---|
Speciality | Psychologist - Rehabilitation |
Location | 5105 200th St Sw Ste 100, Lynnwood, Washington |
Authorized Official Name and Position | Brenda Havellana (NEUROPSYCHOLOGIST) |
Authorized Official Contact | 4253876972 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Washington State Psychological Services, Llc 3224 75th Dr Ne Marysville WA 98270-6804 Ph: (425) 387-6972 | Washington State Psychological Services, Llc 5105 200th St Sw Ste 100 Lynnwood WA 98036-6397 Ph: (425) 387-6972 |
NPI Number | 1801130976 |
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Provider Enumeration Date | 11/15/2012 |
Last Update Date | 11/15/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801130976 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TR0400X | Psychologist - Rehabilitation | PY60014648 (Washington) | Primary |
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