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General NPI Number Information
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NPI Number | 1912786997
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Entity Type | Organization
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Legal Business Name | WONDER TREE DEVELOPMENTAL PSYCHOLOGY, A PROFESSIONAL ORGANIZATION
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 601 MAIN ST STE 200
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City | VANCOUVER
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State | WA
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Zip | 98660-3404
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Country | US
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Telephone | 626-319-9467
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Fax |
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Provider Business Mailing Address
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Address Line | 22804 NE 185TH CIR
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City | BRUSH PRAIRIE
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State | WA
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Zip | 98606-8301
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Country | US
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Telephone | 626-319-9467
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | ASHLEY TAYLOR DOUGHERTY
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Credential | PSY.D.
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Telephone | 626-319-9467
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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 |
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License Number State |
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