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General NPI Number Information
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NPI Number | 1790218410
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Entity Type | Organization
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Legal Business Name | GOTTMAN PRIVATE PRACTICE
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1689 SPRING POINT ROAD
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City | DEER HARBOR
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State | WA
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Zip | 98243
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Country | US
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Telephone | 360-376-4963
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Fax |
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Provider Business Mailing Address
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Address Line | 1689 SPRING POINT ROAD
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City | DEER HARBOR
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State | WA
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Zip | 98243
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Country | US
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Telephone | 360-376-4963
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JULIE SCHWARTZ GOTTMAN
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Credential | PH.D.
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Telephone | 360-376-4963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY00001562
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License Number State | WA
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