Healthcare Provider Details

I. General information

NPI: 1780854356
Provider Name (Legal Business Name): NORTHWEST NEUROPSYCHOLOGY LEARNING AND BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 112TH AVE NE SUITE 202
BELLEVUE WA
98004-2953
US

IV. Provider business mailing address

2227 112TH AVE NE SUITE 202
BELLEVUE WA
98004-2953
US

V. Phone/Fax

Practice location:
  • Phone: 425-452-8036
  • Fax:
Mailing address:
  • Phone: 425-452-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HARRY FAY
Title or Position: OFFICE MANAGER
Credential: ESQ
Phone: 425-452-8036