| NPI | 1205146123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE LEWIS JUDD Owner 360-255-2505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00000736) |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2011-03-30 |