Healthcare Provider Details

I. General information

NPI: 1275329450
Provider Name (Legal Business Name): POINT DEFIANCE PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 N 21ST ST
TACOMA WA
98406-7519
US

IV. Provider business mailing address

4522 JEAN CT W
TACOMA WA
98466-1329
US

V. Phone/Fax

Practice location:
  • Phone: 253-355-5766
  • Fax: 253-944-9188
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN MOORE
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 253-355-5766