Provider Demographics
NPI:1831628031
Name:COLLIER, SAMUEL (PSYD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 SW ALASKA ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2730
Mailing Address - Country:US
Mailing Address - Phone:206-979-8787
Mailing Address - Fax:
Practice Address - Street 1:3515 SW ALASKA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2730
Practice Address - Country:US
Practice Address - Phone:253-234-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61040015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2143215Medicaid