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General NPI Number Information
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NPI Number | 1144695818
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Entity Type | Individual
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Provider Name | JOSEPH WASSIF
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Gender | Male
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 606 N THIRD AVE STE 203
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City | SANDPOINT
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State | ID
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Zip | 83864-1691
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Country | US
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Telephone | 208-265-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 205 S LINCOLN AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-8312
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Country | US
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Telephone | 304-216-5106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY203081
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | PSYPP-203519
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License Number State | ID
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