Provider Demographics
NPI:1932595303
Name:JAMES W INGERSOLL PHD INC PS
Entity type:Organization
Organization Name:JAMES W INGERSOLL PHD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:INGERSOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-561-5730
Mailing Address - Street 1:1115 OLYMPIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4035
Mailing Address - Country:US
Mailing Address - Phone:360-561-5773
Mailing Address - Fax:
Practice Address - Street 1:1115 OLYMPIA AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4035
Practice Address - Country:US
Practice Address - Phone:360-561-5730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-12
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001002544Medicare PIN
WAR31749Medicare UPIN