Provider Demographics
NPI:1740619295
Name:HOLLEY KASKEL PSYD LLC
Entity Type:Organization
Organization Name:HOLLEY KASKEL PSYD LLC
Other - Org Name:CENTER FOR POSITIVE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KASKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-213-9153
Mailing Address - Street 1:16541 REDMOND WAY
Mailing Address - Street 2:#313C
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4492
Mailing Address - Country:US
Mailing Address - Phone:425-996-8592
Mailing Address - Fax:425-667-8402
Practice Address - Street 1:3310 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:URBAN OASIS
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7497
Practice Address - Country:US
Practice Address - Phone:425-996-8592
Practice Address - Fax:425-667-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60079992103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty