Provider Demographics
NPI:1376661025
Name:FAMILY PSYCHOLOGICAL SERVICES OF KIRKLAND, PS
Entity Type:Organization
Organization Name:FAMILY PSYCHOLOGICAL SERVICES OF KIRKLAND, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-576-1817
Mailing Address - Street 1:312 11TH AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5326
Mailing Address - Country:US
Mailing Address - Phone:425-576-1817
Mailing Address - Fax:425-889-8362
Practice Address - Street 1:312 11TH AVE W STE 201
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5326
Practice Address - Country:US
Practice Address - Phone:425-576-1817
Practice Address - Fax:425-889-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY1926103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty