NPIMap

Individual provider Active NPI

David W Agnor, PHD

  • Clinical Psychologist
  • Vancouver, WA
National Provider Identifier
1114971462
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY00001983 Issued in WA
Practice address
9340 NE 76TH St
Vancouver, WA 98662-3721
Phone
(360) 253-4912
Fax
(360) 253-5710
NPI assigned
May 20, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY00001983 WA Primary
Clinical Psychologist 103TC0700X PSY-444 HI

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

Other identifiers 1

IdentifierTypeStateIssuer
7089816MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050524000201 WA Practitioner - Clinical Psychologist 0143133645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Senior Psychology LLCGroup PAC ID 4688729809, 3 clinicians

Practice addresses (Care Compare)

5220 NE Hazel Dell Ave
Vancouver, WA 98663-1242
Phone (360) 993-1474

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY-444HIMDClinical Psychologist
1983WAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Psychology LLC Clinical CurrentSince Jul 1, 2009 Accepting new patients
David W Agnor PHD PC Dba Senior Connections Clinical PastSince Jan 1, 1998 Accepting new patients
Puget Sound Senior Psychology LLC Clinical PastSince Jul 1, 2009 Accepting new patients
Seatac Senior Psychology LLC Clinical PastSince Jul 1, 2009 Accepting new patients
Senior Psychology LLC Clinical Past Accepting new patients
Spokane Senior Psychology LLC Clinical PastSince Jun 24, 2009 Accepting new patients

Locations

5220 NE Hazel Dell Ave
Vancouver, WA 98663
Phone (360) 693-1474

801 SE Park Crest Ave
Vancouver, WA 98683
Phone (360) 253-2879

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

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1114971462",
    "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": "360-253-5710"
        },
        {
            "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": "360-253-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGNOR",
        "first_name": "DAVID",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00001983",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY-444",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7089816",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.