Provider Demographics
NPI:1861866535
Name:WASHINGTON STATE UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON STATE UNIVERSITY
Other - Org Name:PSYCHOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGY CLINIC DIRECTORY
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-335-3587
Mailing Address - Street 1:PO BOX 644820
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164-4820
Mailing Address - Country:US
Mailing Address - Phone:509-335-3587
Mailing Address - Fax:509-335-1030
Practice Address - Street 1:305 NE TROY MALL
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164
Practice Address - Country:US
Practice Address - Phone:509-335-3587
Practice Address - Fax:509-335-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty