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General NPI Number Information
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NPI Number | 1306177480
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Entity Type | Organization
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Legal Business Name | NEVILLE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 18500 156TH AVE NE STE 202
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City | WOODINVILLE
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State | WA
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Zip | 98072-4459
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Country | US
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Telephone | 206-214-7482
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Fax | 425-481-2157
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Provider Business Mailing Address
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Address Line | 18500 156TH AVE NE STE 202
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City | WOODINVILLE
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State | WA
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Zip | 98072-4459
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Country | US
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Telephone | 206-214-7482
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Fax | 425-481-2157
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN NEVILLE
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Credential | PH.D.
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Telephone | 206-214-7482
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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 | PY00001809
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License Number State | WA
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