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General NPI Number Information
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NPI Number | 1033651237
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Entity Type | Organization
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Legal Business Name | DEPTH PSYCHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 11/06/2016
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 108 N WASHINGTON ST STE 408
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City | SPOKANE
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State | WA
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Zip | 99201
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Country | US
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Telephone | 509-220-4398
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Fax | 509-241-3864
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Provider Business Mailing Address
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Address Line | 108 N WASHINGTON ST STE 408
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City | SPOKANE
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State | WA
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Zip | 99201-5001
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Country | US
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Telephone | 509-220-4398
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Fax | 509-241-3864
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Authorized Official
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Title or Position | OWNER & CLINICAL PSYCHOLOGIST
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Name | DR. WARD ROBAK
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Credential | PHD
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Telephone | 509-220-4398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PY60608652
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License Number State | WA
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