Provider Demographics
NPI:1811233414
Name:NEUROPSYCH PROGRAM PLLC
Entity type:Organization
Organization Name:NEUROPSYCH PROGRAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:S H M
Authorized Official - Last Name:VARADA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:509-539-4273
Mailing Address - Street 1:1446 SPAULDING PARK STE 303
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4720
Mailing Address - Country:US
Mailing Address - Phone:509-420-5060
Mailing Address - Fax:509-420-5059
Practice Address - Street 1:1446 SPAULDING PARK STE 303
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4720
Practice Address - Country:US
Practice Address - Phone:509-420-5060
Practice Address - Fax:509-420-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 000388132084P0805X
WAPA 10005331363AM0700X
WAMD 000383362084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty