Healthcare Provider Details

I. General information

NPI: 1740481985
Provider Name (Legal Business Name): LORIEN JEAN NEWSOME PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N MERIDIAN
PUYALLUP WA
98371-8636
US

IV. Provider business mailing address

426 N MERIDIAN
PUYALLUP WA
98371-8636
US

V. Phone/Fax

Practice location:
  • Phone: 734-788-8364
  • Fax: 253-341-4944
Mailing address:
  • Phone: 734-788-8364
  • Fax: 253-341-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60249985
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: