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General NPI Number Information
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NPI Number | 1932595303
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Entity Type | Organization
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Legal Business Name | JAMES W INGERSOLL PHD INC PS
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Dates
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Enumeration Date | 04/12/2015
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Last Update Date | 04/12/2015
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Provider Practice Location Address
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Address Line | 1115 OLYMPIA AVE NE
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City | OLYMPIA
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State | WA
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Zip | 98506-4035
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Country | US
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Telephone | 360-561-5730
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 OLYMPIA AVE NE
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City | OLYMPIA
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State | WA
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Zip | 98506-4035
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Country | US
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Telephone | 360-561-5773
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/PRESIDENT
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Name | JAMES W INGERSOLL
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Credential | PHD
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Telephone | 360-561-5730
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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 | 446
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License Number State | WA
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