Provider Demographics
NPI:1386689925
Name:FITZ, ALLAN (PHD)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:
Last Name:FITZ
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 1:12 BELLWETHER WAY
Mailing Address - Street 2:SUITE 223
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2959
Mailing Address - Country:US
Mailing Address - Phone:360-255-2505
Mailing Address - Fax:360-255-2504
Practice Address - Street 1:12 BELLWETHER WAY
Practice Address - Street 2:SUITE 223
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2959
Practice Address - Country:US
Practice Address - Phone:360-255-2505
Practice Address - Fax:360-255-2504
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001693103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7103690Medicaid
WAS33355Medicare UPIN
WA7103690Medicaid