Provider Demographics
NPI:1063557080
Name:NEAL, BEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:NEAL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CENTRAL WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6162
Mailing Address - Country:US
Mailing Address - Phone:425-576-9094
Mailing Address - Fax:
Practice Address - Street 1:105 CENTRAL WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6162
Practice Address - Country:US
Practice Address - Phone:425-576-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1964103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling