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General NPI Number Information
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NPI Number | 1710199211
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Entity Type | Organization
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Legal Business Name | BARRY A CARLAW PHD INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4606 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4200
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Country | US
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Telephone | 253-564-8322
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Fax | 253-564-1281
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Provider Business Mailing Address
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Address Line | 4606 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4200
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Country | US
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Telephone | 253-564-8322
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Fax | 253-564-1281
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY A CARLAW
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Credential | PH.D
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Telephone | 253-564-8322
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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 | PY00000701
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License Number State | WA
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