MEDICARE: JAMES PETER BERGHUIS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	PY00001836	WA
2	103T00000X	Psychologist	PY00001836	WA

General Provider Information

NPI Number	:	1811987159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PETER BERGHUIS PHD

Provider Business Mailing Address
First Line	:	4525 50TH AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1459
Country	:	US
Telephone Number	:	206-414-8596
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 50TH AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1459
Country	:	US
Telephone Number	:	206-414-8596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/19/2024

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