Provider Demographics
NPI:1114094471
Name:ISUMATAQ CORPORATION
Entity Type:Organization
Organization Name:ISUMATAQ CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-947-6270
Mailing Address - Street 1:750 GEORGE WASHINGTON WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4247
Mailing Address - Country:US
Mailing Address - Phone:509-947-6270
Mailing Address - Fax:509-946-2011
Practice Address - Street 1:750 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4247
Practice Address - Country:US
Practice Address - Phone:509-947-6270
Practice Address - Fax:509-946-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 1911103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPY 1911OtherPSYCHOLOGY LICENSE #