Healthcare Provider Details

I. General information

NPI: 1205356698
Provider Name (Legal Business Name): JOHN DEBERRY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 36TH ST STE 321
SEATTLE WA
98103-8698
US

IV. Provider business mailing address

600 N 36TH ST STE 321
SEATTLE WA
98103-8698
US

V. Phone/Fax

Practice location:
  • Phone: 206-880-0977
  • Fax: 206-299-4617
Mailing address:
  • Phone: 206-880-0977
  • Fax: 206-299-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60729333
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60729333
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY60729333
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: