Provider Demographics
NPI:1619322864
Name:BUWALDA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:BUWALDA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUWALDA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-921-3314
Mailing Address - Street 1:1405 E GUADALUPE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3971
Mailing Address - Country:US
Mailing Address - Phone:480-921-3314
Mailing Address - Fax:
Practice Address - Street 1:1405 E GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3971
Practice Address - Country:US
Practice Address - Phone:480-921-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG7573251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health