Individual provider Active NPI

Harry C Dudley, PSY.D.

  • Forensic Psychologist
  • Vancouver, WA
National Provider Identifier
1164647046
Registry record updated Jan 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Forensic PsychologistTaxonomy code 103TF0200X
License
1794 Issued in WA
Practice address
7600 NE 41St St
Suite 310
Vancouver, WA 98662-6791
Phone
(360) 253-6425
Fax
(360) 253-3196
NPI assigned
Apr 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Forensic Psychologist 103TF0200X 1794 WA Primary

Addresses

Primary practice location

7600 NE 41St St
Suite 310
Vancouver, WA 98662-6791

Mailing address

7600 NE 41St St
Suite 310
Vancouver, WA 98662-6728
Phone (360) 253-6425

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190328002244 WA Practitioner - Clinical Psychologist 8921348954 Practice locations: Vancouver, WA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

7600 NE 41St St
Suite 203
Vancouver, WA 98662-6772
Phone (360) 253-6425

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1794WAMDForensic Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Whipple Creek Wellness Incorporated PastSince Feb 23, 2025 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1164647046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 NE 41ST ST",
            "address_2": "SUITE 310",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626728",
            "telephone_number": "360-253-6425",
            "fax_number": "360-253-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 NE 41ST ST",
            "address_2": "SUITE 310",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626791",
            "telephone_number": "360-253-6425",
            "fax_number": "360-253-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "HARRY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2012-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "WA",
            "license": "1794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.