Organization Active NPI

Center for Child Development

  • Clinical Neuropsychologist
  • Issaquah, WA
National Provider Identifier
1487094736
Registry record updated Jul 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
CENTER FOR CHILD DEVELOPMENT
Practice address
1700 NW Gilman Blvd Ste 205
Issaquah, WA 98027-5364
Phone
(425) 877-3484
NPI assigned
Jul 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2013

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

Authorized official

Name
Phillip Dunbar-Mayer, PSYD
Title
Owner
Phone
(425) 877-3484

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X Primary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X

Addresses

Primary practice location

1700 NW Gilman Blvd Ste 205
Issaquah, WA 98027-5364

Mailing address

PO Box 66
Issaquah, WA 98027-0004
Phone (425) 877-3484

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1487094736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980270004",
            "telephone_number": "425-877-3484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NW GILMAN BLVD STE 205",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275364",
            "telephone_number": "425-877-3484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR CHILD DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-01",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "DUNBAR-MAYER",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-877-3484",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; 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.