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General NPI Number Information
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NPI Number | 1497114342
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Entity Type | Organization
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Legal Business Name | OLYMPIC PSYCHOLOGY SERVICES, PLLC
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 711 COURT A STE 114
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City | TACOMA
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State | WA
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Zip | 98402-5227
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Country | US
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Telephone | 253-269-6063
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Fax | 360-539-5938
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Provider Business Mailing Address
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Address Line | 711 COURT A STE 114
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City | TACOMA
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State | WA
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Zip | 98402-5227
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Country | US
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Telephone | 253-269-6063
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Fax | 360-539-5938
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. LISA HARDEBECK
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Credential | PH.D.
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Telephone | 253-269-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY2596
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License Number State | WA
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