Healthcare Provider Details

I. General information

NPI: 1326338468
Provider Name (Legal Business Name): THOMAS ROE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 S UNION AVE STE 100
TACOMA WA
98405-1306
US

IV. Provider business mailing address

2420 S UNION AVE STE 100
TACOMA WA
98405-1306
US

V. Phone/Fax

Practice location:
  • Phone: 253-201-3831
  • Fax: 253-276-6624
Mailing address:
  • Phone: 253-201-3831
  • Fax: 253-276-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60546803
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number23472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: