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General NPI Number Information
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NPI Number | 1346274289
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Entity Type | Organization
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Legal Business Name | PENINSULA PSYCHOLOGICAL CENTER, INC., P.S.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 1191 NW TAHOE
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City | SILVERDALE
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State | WA
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Zip | 98383
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Country | US
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Telephone | 360-698-4860
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Fax | 360-698-3849
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Provider Business Mailing Address
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Address Line | 1191 NW TAHOE LANEPO BOX 3428
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City | SILVERDALE
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State | WA
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Zip | 98383
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Country | US
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Telephone | 360-698-4860
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Fax | 360-698-3849
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLIOTT RICHELSON
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Credential | AUTHORIZED OFFICIAL
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Telephone | 904-605-4983
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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 | PY00001490
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License Number State | WA
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