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General NPI Number Information
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NPI Number | 1023050523
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Entity Type | Organization
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Legal Business Name | SOUND PSYCHOLOGICAL ASSOCIATES PS
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 2607 BRIDGEPORT WAY W 2E2
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4700
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Country | US
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Telephone | 253-272-7761
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Fax | 253-383-2385
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Provider Business Mailing Address
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Address Line | 2607 BRIDGEPORT WAY W 2E2
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4700
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Country | US
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Telephone | 253-272-7761
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Fax | 253-383-2385
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DAVID CORNWELL BROSE
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Credential | PHD
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Telephone | 253-272-7761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY00000297
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License Number State | WA
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