Healthcare Provider Details

I. General information

NPI: 1053559708
Provider Name (Legal Business Name): DAVID PETER MONSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633A PARKMONT LN SW STE F
OLYMPIA WA
98502-1167
US

IV. Provider business mailing address

2633A PARKMONT LN SW STE F
OLYMPIA WA
98502-1167
US

V. Phone/Fax

Practice location:
  • Phone: 360-870-8744
  • Fax: 360-352-3289
Mailing address:
  • Phone: 360-870-8744
  • Fax: 360-996-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 00001768
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY 00001768
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 00001768
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 00001768
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 00001768
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY 00001768
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: