Provider Demographics
NPI:1912786997
Name:WONDER TREE DEVELOPMENTAL PSYCHOLOGY, A PROFESSIONAL ORGANIZATION
Entity Type:Organization
Organization Name:WONDER TREE DEVELOPMENTAL PSYCHOLOGY, A PROFESSIONAL ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-319-9467
Mailing Address - Street 1:22804 NE 185TH CIR
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-8301
Mailing Address - Country:US
Mailing Address - Phone:626-319-9467
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3404
Practice Address - Country:US
Practice Address - Phone:626-319-9467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty