Healthcare Provider Details

I. General information

NPI: 1538351135
Provider Name (Legal Business Name): ESPRIT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7106 FORD DR NW
GIG HARBOR WA
98335-6482
US

IV. Provider business mailing address

7106 FORD DR NW
GIG HARBOR WA
98335-6482
US

V. Phone/Fax

Practice location:
  • Phone: 253-265-1448
  • Fax: 253-265-1448
Mailing address:
  • Phone: 253-265-1448
  • Fax: 253-265-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY00002742
License Number StateWA

VIII. Authorized Official

Name: DR. MARGO WADE WALSH
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: PHD
Phone: 253-265-1448