Healthcare Provider Details

I. General information

NPI: 1154404028
Provider Name (Legal Business Name): SAMMAMISH VALLEY PSYCHOLOGICAL SERVICES, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17530 NE UNION HILL RD SUITE 210
REDMOND WA
98052
US

IV. Provider business mailing address

17530 NE UNION HILL RD SUITE 210
REDMOND WA
98052
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-2623
  • Fax: 425-883-6241
Mailing address:
  • Phone: 425-883-2623
  • Fax: 425-883-6241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGG T SCHIMMEL
Title or Position: OWNER DIRECTOR
Credential: PHD
Phone: 425-883-2623