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General NPI Number Information
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NPI Number | 1609948678
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Entity Type | Individual
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Provider Name | ROSS LOWELL MAYBERRY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 1402 10TH PL N
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City | EDMONDS
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State | WA
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Zip | 98020-2629
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Country | US
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Telephone | 206-735-9592
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Fax | 206-323-7324
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Provider Business Mailing Address
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Address Line | 1402 10TH PL N
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City | EDMONDS
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State | WA
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Zip | 98020-2629
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Country | US
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Telephone | 206-735-9592
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Fax | 206-323-7324
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY 1297
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | WAPSY1297
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License Number State | WA
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