Provider Demographics
NPI:1558863993
Name:INSIGHT PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:INSIGHT PSYCHOLOGY, PLLC
Other - Org Name:INSIGHT PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAGOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-876-1793
Mailing Address - Street 1:885 HEDINE RD
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8716
Mailing Address - Country:US
Mailing Address - Phone:509-876-1793
Mailing Address - Fax:
Practice Address - Street 1:409 E SUMACH ST STE 3
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1202
Practice Address - Country:US
Practice Address - Phone:509-876-1793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60236271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty