=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639367352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ASTRID DAVIDSON, PSY,D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2007
-----------------------------------------------------
Last Update Date | 10/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14042 NE 8TH ST STE 102
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98007-4142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-455-4890
-----------------------------------------------------
Fax | 425-643-0352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7083
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98008-1083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-455-4890
-----------------------------------------------------
Fax | 425-643-0352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ASTRID DAVIDSON
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 425-455-4890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY00002916
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------