Healthcare Provider Details

I. General information

NPI: 1124164751
Provider Name (Legal Business Name): SPOKANE PSYCHIATRY AND PSYCHOLOGY, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEST 8TH AVE STE 408
SPOKANE WA
99204-2318
US

IV. Provider business mailing address

105 WEST 8TH AVE STE 408
SPOKANE WA
99204-2318
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-8660
  • Fax: 509-455-8662
Mailing address:
  • Phone: 509-455-8660
  • Fax: 509-455-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number445
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number445
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0015023
License Number StateWA

VIII. Authorized Official

Name: JAMES CLIFFORD GREEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 509-455-8660