Provider Demographics
NPI:1295355923
Name:WEAR, DOUGLAS M (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:WEAR
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 16TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2517
Mailing Address - Country:US
Mailing Address - Phone:206-547-4221
Mailing Address - Fax:
Practice Address - Street 1:5802 16TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2517
Practice Address - Country:US
Practice Address - Phone:206-547-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60393642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical