Healthcare Provider Details

I. General information

NPI: 1750392718
Provider Name (Legal Business Name): WAYNE ALLEN HUME JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22517 7TH AVE S
DES MOINES WA
98198-6820
US

IV. Provider business mailing address

22517 7TH AVE S
DES MOINES WA
98198-6820
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-6262
  • Fax: 206-870-9081
Mailing address:
  • Phone: 206-824-6262
  • Fax: 206-870-9081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY00002976
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: