Active NPI
Vincent Thomas Gollogly, PH.D.
- Clinical Psychologist
- Lakewood, WA
National Provider Identifier
1043686991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00002233
- Practice address
- 11444 Gravelly Lake Dr SW
Lakewood, WA 98499-1404 - Phone
- (253) 223-2525
- NPI assigned
- Aug 14, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00002233 | WA | Primary |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | PY00002233 | WA |
Addresses
Primary practice location
11444 Gravelly Lake Dr SW
Lakewood, WA 98499-1404
Mailing address
11444 Gravelly Lake Dr SW
Lakewood, WA 98499-1404
Phone (253) 223-2525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00002233 | WA | MD | Intellectual & Developmental Disabilities Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439510400000",
"number": "1043686991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11444 GRAVELLY LAKE DR SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984991404",
"telephone_number": "253-223-2525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11444 GRAVELLY LAKE DR SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984991404",
"telephone_number": "253-223-2525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLLOGLY",
"first_name": "VINCENT",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-14",
"last_updated": "2015-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00002233",
"primary": true
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "WA",
"license": "PY00002233",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.