Provider Demographics
NPI:1154404028
Name:SAMMAMISH VALLEY PSYCHOLOGICAL SERVICES, P.S.
Entity type:Organization
Organization Name:SAMMAMISH VALLEY PSYCHOLOGICAL SERVICES, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCHIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-883-2623
Mailing Address - Street 1:17530 NE UNION HILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-883-2623
Mailing Address - Fax:425-883-6241
Practice Address - Street 1:17530 NE UNION HILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-883-2623
Practice Address - Fax:425-883-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0043575OtherDEPT OF L AND I
217108900Medicare ID - Type Unspecified