Provider Demographics
NPI:1013049378
Name:REHABILITATION PSYCHOLOGY SERVICES P S
Entity Type:Organization
Organization Name:REHABILITATION PSYCHOLOGY SERVICES P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:R
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-255-2505
Mailing Address - Street 1:801 SAMISH WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2940
Mailing Address - Country:US
Mailing Address - Phone:360-255-2505
Mailing Address - Fax:360-255-2504
Practice Address - Street 1:801 SAMISH WAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229
Practice Address - Country:US
Practice Address - Phone:360-255-2505
Practice Address - Fax:360-255-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8875673Medicare PIN