Provider Demographics
NPI:1023050523
Name:SOUND PSYCHOLOGICAL ASSOCIATES PS
Entity type:Organization
Organization Name:SOUND PSYCHOLOGICAL ASSOCIATES PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CORNWELL
Authorized Official - Last Name:BROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-272-7761
Mailing Address - Street 1:2607 BRIDGEPORT WAY W
Mailing Address - Street 2:2E2
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4700
Mailing Address - Country:US
Mailing Address - Phone:253-272-7761
Mailing Address - Fax:253-383-2385
Practice Address - Street 1:2607 BRIDGEPORT WAY W
Practice Address - Street 2:2E2
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4700
Practice Address - Country:US
Practice Address - Phone:253-272-7761
Practice Address - Fax:253-383-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000297103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001000143Medicare ID - Type Unspecified