Provider Demographics
NPI:1669740353
Name:PAMELA VAN DALFSEN, PH.D., INC., P.S.
Entity type:Organization
Organization Name:PAMELA VAN DALFSEN, PH.D., INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN DALFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-325-7222
Mailing Address - Street 1:2915 E MADISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4265
Mailing Address - Country:US
Mailing Address - Phone:206-325-7222
Mailing Address - Fax:
Practice Address - Street 1:2915 E MADISON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4265
Practice Address - Country:US
Practice Address - Phone:206-325-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY0001274261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health