Provider Demographics
NPI:1386931608
Name:SCHOLTZ, BRENDON (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:
Last Name:SCHOLTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16731 188TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9197
Mailing Address - Country:US
Mailing Address - Phone:914-255-1955
Mailing Address - Fax:
Practice Address - Street 1:16731 188TH PL NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9197
Practice Address - Country:US
Practice Address - Phone:914-255-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60104094103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic