Provider Demographics
NPI:1609149939
Name:CHUCK WEISSER PHD PC
Entity Type:Organization
Organization Name:CHUCK WEISSER PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-993-2939
Mailing Address - Street 1:1007 OFFICERS ROW
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3851
Mailing Address - Country:US
Mailing Address - Phone:360-993-2939
Mailing Address - Fax:
Practice Address - Street 1:1007 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3851
Practice Address - Country:US
Practice Address - Phone:360-993-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8896293Medicare UPIN