Provider Demographics
NPI:1346634599
Name:NORTHWEST PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHWEST PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:CREATIVE PSYCHOLOGY WITH DR. DUG PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUG
Authorized Official - Middle Name:Y L
Authorized Official - Last Name:LEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-480-0911
Mailing Address - Street 1:428 SOUTH MAIN ST
Mailing Address - Street 2:UNIT 1069 STE B
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7012
Mailing Address - Country:US
Mailing Address - Phone:404-480-0911
Mailing Address - Fax:
Practice Address - Street 1:2310 130TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1761
Practice Address - Country:US
Practice Address - Phone:206-569-8027
Practice Address - Fax:206-694-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8938788Medicare PIN