Provider Demographics
NPI:1104947142
Name:OLYMPIC PSYCHIATRIC ASSOC.,P.S.
Entity type:Organization
Organization Name:OLYMPIC PSYCHIATRIC ASSOC.,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-452-8991
Mailing Address - Street 1:819 GEORGIANA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3511
Mailing Address - Country:US
Mailing Address - Phone:360-452-8991
Mailing Address - Fax:360-452-8993
Practice Address - Street 1:819 GEORGIANA ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3511
Practice Address - Country:US
Practice Address - Phone:360-452-8991
Practice Address - Fax:360-452-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)