Healthcare Provider Details

I. General information

NPI: 1104503473
Provider Name (Legal Business Name): PSYCHOLOGICAL CONSULTING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 BROADWAY UNIT 611
TACOMA WA
98402-4003
US

IV. Provider business mailing address

252 BROADWAY UNIT 611
TACOMA WA
98402-4003
US

V. Phone/Fax

Practice location:
  • Phone: 253-325-8044
  • Fax:
Mailing address:
  • Phone: 253-325-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY GABRIELLE PATTERSON-HYATT
Title or Position: CLINICAL PSYCHOLOGY DIRECTOR ANDCEO
Credential: PSY.D.,M.S., M.A.
Phone: 347-266-6748