NPIMap

Organization Active NPI

Olympic Psychology Services, PLLC

  • Community/Behavioral Health Agency
  • Tacoma, WA
National Provider Identifier
1497114342
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
PY2596 Issued in WA
Legal business name
OLYMPIC PSYCHOLOGY SERVICES, PLLC
Practice address
711 Court a Ste 114
Tacoma, WA 98402-5227
Phone
(253) 269-6063
Fax
(360) 539-5938
NPI assigned
Feb 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
Dr. Lisa Hardebeck, PH.D.
Title
Licensed Clinical Psychologist
Phone
(253) 269-6063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X PY2596 WA Primary

Addresses

Primary practice location

711 Court a Ste 114
Tacoma, WA 98402-5227

Mailing address

711 Court a Ste 114
Tacoma, WA 98402-5227
Phone (253) 269-6063

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190718000664 WA Part B Supplier - Clinic/Group Practice 8527393156 Receives reassigned benefits from 12 practitioners
Practice locations: Tacoma, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1497114342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 COURT A STE 114",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025227",
            "telephone_number": "253-269-6063",
            "fax_number": "360-539-5938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 COURT A STE 114",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025227",
            "telephone_number": "253-269-6063",
            "fax_number": "360-539-5938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC PSYCHOLOGY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-22",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "HARDEBECK",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "253-269-6063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "PY2596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.