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General NPI Number Information
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NPI Number | 1275329450
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Entity Type | Organization
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Legal Business Name | POINT DEFIANCE PSYCHOLOGY
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 2711 N 21ST ST
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City | TACOMA
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State | WA
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Zip | 98406-7519
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Country | US
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Telephone | 253-355-5766
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Fax | 253-944-9188
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Provider Business Mailing Address
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Address Line | 4522 JEAN CT W
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City | TACOMA
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State | WA
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Zip | 98466-1329
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JONATHAN MOORE
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Credential | PHD
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Telephone | 253-355-5766
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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