Provider Demographics
NPI:1205146123
Name:NEUROPSYCHOLOGICAL AND PSYCHOEDUCATIONAL SERVICES
Entity type:Organization
Organization Name:NEUROPSYCHOLOGICAL AND PSYCHOEDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-255-2505
Mailing Address - Street 1:12 BELLWETHER WAY
Mailing Address - Street 2:SUITE 223
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2959
Mailing Address - Country:US
Mailing Address - Phone:360-255-2505
Mailing Address - Fax:360-255-2504
Practice Address - Street 1:12 BELLWETHER WAY
Practice Address - Street 2:SUITE 223
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2959
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:2010-10-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty