Individual provider Active NPI

Troy Edward Fenlason, PSY.D.

  • Clinical Psychologist
  • Leavenworth, WA
National Provider Identifier
1396887477
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY60090118 Issued in WA
Practice address
12437 Plain Ranches Rd
Leavenworth, WA 98826-9744
Phone
(425) 275-2637
Fax
(206) 299-2289
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY60090118 WA Primary

Addresses

Primary practice location

12437 Plain Ranches Rd
Leavenworth, WA 98826-9744

Mailing address

PO Box 2107
Leavenworth, WA 98826-2107
Phone (425) 275-2637

Other practice location 1

316 Main St Ste A2
Edmonds, WA 98020-3197
Phone (425) 275-2637

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PY60090118WAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Erh Inc Clinical CurrentSince Dec 8, 2024 Accepting new patients

Locations

316 Main St
Ste A2
Edmonds, WA 98020
Phone (425) 275-2637

2611 NE 125th St
Ste 111
Seattle, WA 98125
Phone (206) 324-3581

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1396887477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2107",
            "city": "LEAVENWORTH",
            "state": "WA",
            "postal_code": "988262107",
            "telephone_number": "425-275-2637",
            "fax_number": "206-299-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12437 PLAIN RANCHES RD",
            "city": "LEAVENWORTH",
            "state": "WA",
            "postal_code": "988269744",
            "telephone_number": "425-275-2637",
            "fax_number": "206-299-2289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "316 Main St Ste A2",
            "address_purpose": "LOCATION",
            "city": "Edmonds",
            "state": "WA",
            "postal_code": "980203197",
            "country_code": "US",
            "telephone_number": "425-275-2637",
            "fax_number": "206-299-2289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENLASON",
        "first_name": "TROY",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60090118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leavenworth, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.