Healthcare Provider Details

I. General information

NPI: 1225352263
Provider Name (Legal Business Name): TRINA TOBEY EIDE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OAKESDALE AVE SW STE 104
RENTON WA
98057-5226
US

IV. Provider business mailing address

600 OAKESDALE AVE SW STE 104
RENTON WA
98057-5226
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-5336
  • Fax: 425-228-4540
Mailing address:
  • Phone: 425-228-5336
  • Fax: 425-228-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60167231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: