Active NPI
William John Chalstrom, PH D
- Psychologist
- Port Orchard, WA
National Provider Identifier
1538255658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY00001242
- Practice address
- 2501 Mile Hill Drive
Suite a 105 Port Orchard Clinical Psychology Center
Port Orchard, WA 98366-0776 - Phone
- (360) 876-0285
- Fax
- (360) 876-4685
- NPI assigned
- Oct 5, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY00001242 | WA | Primary |
Addresses
Primary practice location
2501 Mile Hill Drive
Suite a 105 Port Orchard Clinical Psychology Center
Port Orchard, WA 98366-0776
Mailing address
PO Box 776
Port Orchard, WA 98366-0776
Phone (360) 876-0285
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137334 | Other | MANGED HEALTH NETWORK | |
| 7046725 | Medicaid | WA | |
| 37794 | Other | WA | DEPT OF LABOR & INDUSTRIE |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00001242 | WA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538255658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 776",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983660776",
"telephone_number": "360-876-0285",
"fax_number": "360-876-4685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 MILE HILL DRIVE",
"address_2": "SUITE A 105 PORT ORCHARD CLINICAL PSYCHOLOGY CENTER",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983660776",
"telephone_number": "360-876-0285",
"fax_number": "360-876-4685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHALSTROM",
"first_name": "WILLIAM",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PH D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY00001242",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANGED HEALTH NETWORK",
"identifier": "137334",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7046725",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR & INDUSTRIE",
"identifier": "37794",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Orchard, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.