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General NPI Number Information
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NPI Number | 1053749507
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Entity Type | Organization
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Legal Business Name | ACCESS AGENCY & CONNECTION
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1840 146TH PL SE
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City | BELLEVUE
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State | WA
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Zip | 98007-6821
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Country | US
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Telephone | 952-215-1331
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 146TH PL SE
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City | BELLEVUE
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State | WA
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Zip | 98007-6821
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Country | US
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Telephone | 952-215-1331
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MAX HINES
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Credential | PH.D.
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Telephone | 952-215-1331
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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 | PY00001697
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License Number State | WA
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