| NPI | 1639685241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EDWARD LOLLEY Co Owner 206-432-9020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY60345764) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2018-09-12 |