NPIMap

Organization Active NPI

Front Street Clinic Inc

  • Psychologist
  • Poulsbo, WA
National Provider Identifier
1457532913
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY00000965 Issued in WA
Legal business name
FRONT STREET CLINIC INC
Practice address
20174 Front St NE
Poulsbo, WA 98370-7445
Phone
(360) 697-1141
Fax
(360) 697-2395
NPI assigned
Nov 26, 2007
Last updated
Jun 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Authorized official

Name
Olga A Popach, MANAGER
Title
Office Manager
Phone
(360) 697-1141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY00000965 WA Primary

Addresses

Primary practice location

20174 Front St NE
Poulsbo, WA 98370-7445

Mailing address

PO Box 1611
Poulsbo, WA 98370-0197
Phone (360) 697-1141

Other practice location 1

2830 N Swan Rd Ste 140
Tucson, AZ 85712-6301
Phone (360) 697-1141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040304000420 WA Part B Supplier - Clinic/Group Practice 5193612935 Receives reassigned benefits from 10 practitioners
Practice locations: Poulsbo, WA
O20260515000837 AZ Part B Supplier - Clinic/Group Practice 5193612935 Practice locations: Tucson, AZ

National Provider Directory

National Provider Directory

Locations

2830 N Swan Rd
Ste 140
Tucson, AZ 85712
Phone (360) 697-1141

19793 Hamilton Ct NE
Poulsbo, WA 98370
Phone (360) 697-1141

20174 Front St NE
Ste 2B
Poulsbo, WA 98370

2819 NW Kitsap Pl
Ste 2B
Silverdale, WA 98383
Phone (360) 689-4964

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750809600000",
    "number": "1457532913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1611",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983700197",
            "telephone_number": "360-697-1141",
            "fax_number": "360-697-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20174 FRONT ST NE",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707445",
            "telephone_number": "360-697-1141",
            "fax_number": "360-697-2395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2830 N Swan Rd Ste 140",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857126301",
            "country_code": "US",
            "telephone_number": "360-697-1141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FRONT STREET CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-26",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "POPACH",
        "authorized_official_first_name": "OLGA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-697-1141",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY00000965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poulsbo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; 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.