Provider Demographics
NPI:1033651237
Name:DEPTH PSYCHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:DEPTH PSYCHOLOGY SERVICES, LLC
Other - Org Name:WARD ROBAK, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-220-4398
Mailing Address - Street 1:108 N WASHINGTON ST STE 408
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5001
Mailing Address - Country:US
Mailing Address - Phone:509-220-4398
Mailing Address - Fax:509-241-3864
Practice Address - Street 1:108 N WASHINGTON ST STE 408
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-220-4398
Practice Address - Fax:509-241-3864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-06
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60608652261QM0850X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2075526Medicaid