Provider Demographics
NPI:1861864308
Name:DEMONTE, WILLIAM (PSYD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DEMONTE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 SKY ISLAND DR E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7385
Mailing Address - Country:US
Mailing Address - Phone:253-750-6000
Mailing Address - Fax:253-750-6100
Practice Address - Street 1:9230 SKY ISLAND DR E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7385
Practice Address - Country:US
Practice Address - Phone:253-750-6000
Practice Address - Fax:253-750-6100
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60472753103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2062191Medicaid