Healthcare Provider Details

I. General information

NPI: 1093897498
Provider Name (Legal Business Name): QUIXOTE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7038 191ST AVE SW
ROCHESTER WA
98579-8719
US

IV. Provider business mailing address

7038 191ST AVE SW
ROCHESTER WA
98579-8719
US

V. Phone/Fax

Practice location:
  • Phone: 360-561-3259
  • Fax: 360-858-7193
Mailing address:
  • Phone: 360-561-3259
  • Fax: 360-858-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2008
License Number StateWA

VIII. Authorized Official

Name: DR. FRED KEMP
Title or Position: CEO
Credential: PH.D.
Phone: 360-561-3259