NPIMap

Organization Active NPI

Puget Sound Senior Psychology, LLC

  • Adult Care Home Facility
  • Vancouver, WA
National Provider Identifier
1053769844
Registry record updated Jun 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
PY1511 Issued in WA
Legal business name
PUGET SOUND SENIOR PSYCHOLOGY, LLC
Practice address
9340 NE 76TH St
Vancouver, WA 98662-3721
Phone
(360) 253-4912
Fax
(360) 253-5170
NPI assigned
Jun 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2016

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

Authorized official

Name
Dr. David Agnor, PHD
Title
Executive Director
Phone
(360) 253-4912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X PY1511 WA Primary

Addresses

Primary practice location

9340 NE 76TH St
Vancouver, WA 98662-3721

Mailing address

9340 NE 76TH St
Vancouver, WA 98662-3721
Phone (360) 253-4912

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464825600000",
    "number": "1053769844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9340 NE 76TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986623721",
            "telephone_number": "360-253-4912",
            "fax_number": "360-253-5170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9340 NE 76TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986623721",
            "telephone_number": "360-253-4912",
            "fax_number": "360-253-5170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND SENIOR PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-06-02",
        "status": "A",
        "authorized_official_last_name": "AGNOR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-253-4912",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "PY1511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.