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General NPI Number Information
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NPI Number | 1396887477
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Entity Type | Individual
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Provider Name | TROY EDWARD FENLASON PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 12437 PLAIN RANCHES RD
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City | LEAVENWORTH
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State | WA
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Zip | 98826-9744
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Country | US
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Telephone | 425-275-2637
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Fax | 206-299-2289
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Provider Business Mailing Address
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Address Line | PO BOX 2107
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City | LEAVENWORTH
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State | WA
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Zip | 98826-2107
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Country | US
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Telephone | 425-275-2637
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Fax | 206-299-2289
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PY60090118
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License Number State | WA
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