Provider Demographics
NPI:1316715485
Name:KETCHINAE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:KETCHINAE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-484-9352
Mailing Address - Street 1:100 N HOWARD ST STE R
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:425-484-9352
Mailing Address - Fax:
Practice Address - Street 1:22722 29TH DR SE STE 100
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4420
Practice Address - Country:US
Practice Address - Phone:425-484-9352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty