Provider Demographics
NPI:1528283090
Name:DESSELLE, RICHARD E (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:DESSELLE
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 1:4329 209TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-9361
Mailing Address - Country:US
Mailing Address - Phone:425-868-4694
Mailing Address - Fax:
Practice Address - Street 1:16770 NE 79TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4413
Practice Address - Country:US
Practice Address - Phone:425-868-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA617103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical