Healthcare Provider Details

I. General information

NPI: 1801253398
Provider Name (Legal Business Name): THIERRY KOLPIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 02/23/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NE HOSTMARK ST STE 205
POULSBO WA
98370-7538
US

IV. Provider business mailing address

1050 NE HOSTMARK ST STE 205
POULSBO WA
98370-7538
US

V. Phone/Fax

Practice location:
  • Phone: 360-200-8811
  • Fax: 360-900-0321
Mailing address:
  • Phone: 909-992-8500
  • Fax: 360-900-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY61358760
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: