| NPI | 1740461854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DANIEL WAGAMAN Owner/ President 360-866-7406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY 1722) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2010-01-25 |