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General NPI Number Information
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NPI Number | 1063982247
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Entity Type | Organization
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Legal Business Name | CENTER FOR POSITIVE CHANGE LLC
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 1136 WATER ST STE 105
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-6728
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Country | US
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Telephone | 360-385-1030
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Fax | 775-243-9945
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Provider Business Mailing Address
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Address Line | 1136 WATER ST STE 105
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-6728
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Country | US
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Telephone | 360-385-1030
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Fax | 775-243-9945
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY DAVID BERRY
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Credential | PH.D.
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Telephone | 360-385-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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