Healthcare Provider Details

I. General information

NPI: 1467926170
Provider Name (Legal Business Name): TORY ALLISON DURHAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MERCER ST STE 111
SEATTLE WA
98119-3958
US

IV. Provider business mailing address

200 W MERCER ST STE 111
SEATTLE WA
98119-3958
US

V. Phone/Fax

Practice location:
  • Phone: 206-420-4701
  • Fax:
Mailing address:
  • Phone: 206-420-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60812782
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: