Healthcare Provider Details

I. General information

NPI: 1306245212
Provider Name (Legal Business Name): BELLE CHENAULT, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 POWER AVE
SEATTLE WA
98122-6546
US

IV. Provider business mailing address

170 POWER AVE
SEATTLE WA
98122-6546
US

V. Phone/Fax

Practice location:
  • Phone: 206-465-8068
  • Fax:
Mailing address:
  • Phone: 206-465-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60232330
License Number StateWA

VIII. Authorized Official

Name: DR. BELLE CHENAULT
Title or Position: LICENSED PSYCHOLOGIST
Credential:
Phone: 206-465-8068