Healthcare Provider Details

I. General information

NPI: 1659521912
Provider Name (Legal Business Name): WAYNE E CARR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NA NA NA NA

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N E BOTHELL WAY SUITE 155 B
KENMORE WA
98028
US

IV. Provider business mailing address

8725 MAIN ST
EDMONDS WA
98026
US

V. Phone/Fax

Practice location:
  • Phone: 425-488-5496
  • Fax: 425-952-9275
Mailing address:
  • Phone: 425-488-5496
  • Fax: 425-952-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPY00002543
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY00002543
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002543
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY00002543
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY00002543
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY00002543
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY00002543
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: