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General NPI Number Information
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NPI Number | 1841665841
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGICAL SERVICES OF PORT TOWNSEND, PLLC
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 1322 WASHINGTON ST UNIT 17
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-6862
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Country | US
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Telephone | 360-344-8429
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Fax | 360-344-8429
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Provider Business Mailing Address
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Address Line | 1322 WASHINGTON ST UNIT 1733
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-6837
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Country | US
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Telephone | 360-344-8429
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DIANA L DAVIS
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Credential | PH.D
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Telephone | 360-344-8429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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