NPIMap

Organization Active NPI

Peninsula Psychological Center, Inc., P.S.

  • Clinical Psychologist
  • Silverdale, WA
National Provider Identifier
1346274289
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY00001490 Issued in WA
Legal business name
PENINSULA PSYCHOLOGICAL CENTER, INC., P.S.
Practice address
1191 NW Tahoe
Silverdale, WA 98383
Phone
(360) 698-4860
Fax
(360) 698-3849
NPI assigned
Jul 10, 2006
Last updated
May 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Authorized official

Name
Dr. Elliott Richelson, AUTHORIZED OFFICIAL
Title
President
Phone
(904) 605-4983

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PY00001490 WA Primary

Addresses

Primary practice location

1191 NW Tahoe
Silverdale, WA 98383

Mailing address

1191 NW Tahoe Lanepo Box 3428
Silverdale, WA 98383
Phone (360) 698-4860

National Provider Directory

National Provider Directory

Locations

9431 Coppertop Loop NE
Unit B
Bainbridge Island, WA 98110
Phone (206) 855-9535

700 Prospect St
Ste 205
Port Orchard, WA 98366
Phone (360) 895-1955

1307 N 45th St
Ste 200
Seattle, WA 98103
Phone (206) 420-4701

1191 NW Tahoe Ln
Silverdale, WA 98383
Phone (360) 698-4860

1191 NW Tahoe Ln
#3428
Silverdale, WA 98383

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1346274289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 NW TAHOE LANEPO BOX 3428",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "98383",
            "telephone_number": "360-698-4860",
            "fax_number": "360-698-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 NW TAHOE",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "98383",
            "telephone_number": "360-698-4860",
            "fax_number": "360-698-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PSYCHOLOGICAL CENTER, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "RICHELSON",
        "authorized_official_first_name": "ELLIOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-605-4983",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AUTHORIZED OFFICIAL"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00001490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverdale, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; 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.