NPIMap

Organization Active NPI

Puget Sound Senior Psychology LLC

  • Clinical Psychologist
  • Vancouver, WA
National Provider Identifier
1376770222
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY00001983 Issued in WA
Legal business name
PUGET SOUND SENIOR PSYCHOLOGY LLC
Doing business as
Senior Connections
Practice address
9340 NE 76TH St
Vancouver, WA 98662-3721
Phone
(360) 253-4912
Fax
(360) 253-5170
NPI assigned
Jun 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PY00001983 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

Other names 1

  • Senior Connections Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Puget Sound Senior Psychology LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1376770222",
    "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": "2009-06-18",
        "last_updated": "2009-06-18",
        "status": "A",
        "authorized_official_last_name": "AGNOR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W",
        "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": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00001983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Connections",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 18, 2009; 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.