NPIMap

Organization Active NPI

Valley Psychological Services

  • Psychologist
  • Ellensburg, WA
National Provider Identifier
1356842785
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY60253453 Issued in WA
Legal business name
VALLEY PSYCHOLOGICAL SERVICES
Practice address
2109 W Dolarway Rd
Ellensburg, WA 98926-9367
Phone
(509) 968-5086
Fax
(844) 755-6412
NPI assigned
Feb 21, 2018
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Lisa Martin, PHDNPI 1427319052
Title
Owner / Psychologist
Phone
(509) 201-1616

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PY60253453 WA Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X

Addresses

Primary practice location

2109 W Dolarway Rd
Ellensburg, WA 98926-9367

Mailing address

2109 W Dolarway Rd
Ellensburg, WA 98926-9367
Phone (509) 968-5086

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180511001104 WA Part B Supplier - Clinic/Group Practice 3274897665 Receives reassigned benefits from 19 practitioners
Practice locations: Ellensburg, WA

National Provider Directory

National Provider Directory

Locations

206 W 1st Ave
Ellensburg, WA 98926
Phone (253) 951-3614

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1356842785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 W DOLARWAY RD",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989269367",
            "telephone_number": "509-968-5086",
            "fax_number": "844-755-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 W DOLARWAY RD",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989269367",
            "telephone_number": "509-968-5086",
            "fax_number": "844-755-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER / PSYCHOLOGIST",
        "authorized_official_telephone_number": "509-201-1616",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60253453",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellensburg, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.