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General NPI Number Information
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NPI Number | 1265261010
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Entity Type | Organization
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Legal Business Name | DYNAMIC BALANCE PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1505 SHAKESPEARE DR
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City | CENTRALIA
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State | WA
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Zip | 98531-8501
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Country | US
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Telephone | 360-360-5044
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 HARRISON AVE # 269
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City | CENTRALIA
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State | WA
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Zip | 98531-1852
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Country | US
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Telephone | 360-360-5044
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | HEIDI RACHELLE TENNYSON
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Credential | PSY.D.
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Telephone | 360-360-5044
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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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