Healthcare Provider Details

I. General information

NPI: 1598530248
Provider Name (Legal Business Name): PACIFIC COAST PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SW ALASKA ST
SEATTLE WA
98126-2730
US

IV. Provider business mailing address

5326 SW MANNING ST
SEATTLE WA
98116-3128
US

V. Phone/Fax

Practice location:
  • Phone: 253-234-7226
  • Fax:
Mailing address:
  • Phone: 253-234-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL COLLIER
Title or Position: OWNER
Credential: PSYD
Phone: 253-234-7226