Provider Demographics
NPI:1710190186
Name:DANIEL G THOMSEN PHD PS
Entity Type:Organization
Organization Name:DANIEL G THOMSEN PHD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:THOMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-347-7275
Mailing Address - Street 1:127 E INTERCITY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2732
Mailing Address - Country:US
Mailing Address - Phone:425-347-7275
Mailing Address - Fax:425-355-0626
Practice Address - Street 1:127 E INTERCITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2732
Practice Address - Country:US
Practice Address - Phone:425-347-7275
Practice Address - Fax:425-355-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty