Provider Demographics
NPI:1891992293
Name:INDEPENDENT PSYCHOLOGISTS
Entity type:Organization
Organization Name:INDEPENDENT PSYCHOLOGISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-595-5225
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2413
Mailing Address - Country:US
Mailing Address - Phone:509-595-5225
Mailing Address - Fax:509-334-5515
Practice Address - Street 1:1256 SE BISHOP BOULEVARD
Practice Address - Street 2:SUITE M
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2413
Practice Address - Country:US
Practice Address - Phone:509-595-5225
Practice Address - Fax:509-334-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1626103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty