Mahanaim Psychology Services, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

MAHANAIM PSYCHOLOGY SERVICES, PLLC

Practice address

110 W Crawford St Ste F
Deer Park, WA 99006-5356

Phone

(509) 276-5644

Fax

(509) 780-4394

NPI assigned

Jul 7, 2014

Last updated

Nov 19, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Leslie G Brost, PSYDNPI 1265527576

Title

President of Corporation/Provider

Phone

(509) 276-5644

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leslie Gambill Brost, PSYD

  • Clinical Psychologist
  • Deer Park, WA
  • NPI 1265527576
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574121600000",
    "number": "1033525423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2110",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990062110",
            "telephone_number": "509-276-5644",
            "fax_number": "509-276-5644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W CRAWFORD ST STE F",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990065356",
            "telephone_number": "509-276-5644",
            "fax_number": "509-780-4394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHANAIM PSYCHOLOGY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2019-11-19",
        "status": "A",
        "authorized_official_last_name": "BROST",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION/PROVIDER",
        "authorized_official_telephone_number": "509-276-5644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Living Path Counseling LLC
• Lori Tetsuro McDonald (Hearing Center of Deer Park LLC)
• Kendahl Ann Ludiker, PA
• Carey Ann Mack, PT
• Michael Magennis, CRNA
• Jeremy Kyle Marcuson, O.D.
• Melissa Ann McCollough, LMP
• Lori T McDonald, HIS, AAS
• Jennifer L McLaughlin, LMT
• Andrea Janelle Melton, DENTAL HYGIENIST

• Clinical Psychologist in Deer Park, WA
• Providers in Deer Park, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.