Healthcare Provider Details

I. General information

NPI: 1437382140
Provider Name (Legal Business Name): JAMES MAXSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S 12TH AVE STE 4B
YAKIMA WA
98902-3137
US

IV. Provider business mailing address

307 S 12TH AVE STE 4B
YAKIMA WA
98902-3137
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8457
  • Fax: 509-453-1273
Mailing address:
  • Phone: 509-575-8457
  • Fax: 509-453-1273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60860492
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1465
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: