Provider Demographics
NPI:1497114342
Name:OLYMPIC PSYCHOLOGY SERVICES, PLLC
Entity Type:Organization
Organization Name:OLYMPIC PSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-269-6063
Mailing Address - Street 1:711 COURT A STE 114
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5227
Mailing Address - Country:US
Mailing Address - Phone:253-269-6063
Mailing Address - Fax:360-539-5938
Practice Address - Street 1:711 COURT A STE 114
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5227
Practice Address - Country:US
Practice Address - Phone:253-269-6063
Practice Address - Fax:360-539-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2596251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health