Provider Demographics
NPI:1164752507
Name:DUNBAR-MAYER, PHILIP (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:DUNBAR-MAYER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5349
Mailing Address - Country:US
Mailing Address - Phone:425-877-3484
Mailing Address - Fax:425-427-2477
Practice Address - Street 1:1700 NW GILMAN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5349
Practice Address - Country:US
Practice Address - Phone:425-877-3484
Practice Address - Fax:425-427-2477
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003829103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent