Provider Demographics
NPI:1063507895
Name:HIRSCH, PHILIP ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALAN
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 NE 169TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6139
Mailing Address - Country:US
Mailing Address - Phone:425-349-6320
Mailing Address - Fax:425-349-6325
Practice Address - Street 1:2237 NE 169TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-6139
Practice Address - Country:US
Practice Address - Phone:425-349-6320
Practice Address - Fax:425-349-6325
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001117103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling