Healthcare Provider Details

I. General information

NPI: 1033651237
Provider Name (Legal Business Name): DEPTH PSYCHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2016
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N WASHINGTON ST STE 408
SPOKANE WA
99201
US

IV. Provider business mailing address

108 N WASHINGTON ST STE 408
SPOKANE WA
99201-5001
US

V. Phone/Fax

Practice location:
  • Phone: 509-220-4398
  • Fax: 509-241-3864
Mailing address:
  • Phone: 509-220-4398
  • Fax: 509-241-3864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY60608652
License Number StateWA

VIII. Authorized Official

Name: DR. WARD ROBAK
Title or Position: OWNER & CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 509-220-4398