=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265832851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAYNE DEES PSYCHOLOGICAL ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2014
-----------------------------------------------------
Last Update Date | 09/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12500 BARKER CYPRESS RD 5201
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-8239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-658-7459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2320
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77410-2320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-658-7459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WAYNE C DEES
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 206-658-7459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 34276
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------