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General NPI Number Information
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NPI Number | 1770370009
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Entity Type | Organization
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Legal Business Name | EXTRA YEARS PSYCHOLOGY CALIFORNIA PC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 999 3RD AVE STE 3300
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City | SEATTLE
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State | WA
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Zip | 98104-4002
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Country | US
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Telephone | 206-801-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 999 3RD AVE STE 3300
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City | SEATTLE
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State | WA
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Zip | 98104-4002
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Country | US
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Telephone | 206-801-1621
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Fax |
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Authorized Official
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Title or Position | HEAD OF NEUROPSYCHOLOGICAL SERVICES
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Name | DR. DANIEL FENTON
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Credential | PHD
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Telephone | 206-801-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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