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General NPI Number Information
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NPI Number | 1518231893
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Entity Type | Organization
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Legal Business Name | SOUTH WHIDBEY PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 03/03/2012
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 11042 SR 525 SUITE 206
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City | CLINTON
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State | WA
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Zip | 98236-8600
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Country | US
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Telephone | 360-341-4484
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Fax | 866-627-8142
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Provider Business Mailing Address
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Address Line | PO BOX 439
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City | CLINTON
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State | WA
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Zip | 98236-0439
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Country | US
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Telephone | 360-341-4484
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Fax | 866-627-8142
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | DR. FAULDER COLBY
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Credential | PH.D.
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Telephone | 360-341-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY 00001909
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 00001909
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PY 00001909
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License Number State | WA
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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 | PY 00001909
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License Number State | WA
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