Washington State Psychological Services, LLC

Primary specialty

Rehabilitation PsychologistTaxonomy code 103TR0400X

License

PY60014648 Issued in WA

Legal business name

WASHINGTON STATE PSYCHOLOGICAL SERVICES, LLC

Practice address

5105 200TH St SW Ste 100
Lynnwood, WA 98036-6397

Phone

(425) 387-6972

Fax

(425) 377-0701

NPI assigned

Nov 15, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Brenda Havellana, PHDNPI 1568625895

Title

Neuropsychologist

Phone

(425) 387-6972

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Brenda Kay Havellana, PH.D.

  • Rehabilitation Psychologist
  • Marysville, WA
  • NPI 1568625895
  NPD (past) Authorized official

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1801130976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3224 75TH DR NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982706804",
            "telephone_number": "425-387-6972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5105 200TH ST SW STE 100",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366397",
            "telephone_number": "425-387-6972",
            "fax_number": "425-377-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON STATE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "HAVELLANA",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "425-387-6972",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": "WA",
            "license": "PY60014648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felisa Virginia Warren
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• Washington Dental Corporation, PC
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• Olivia Wasilenski
• Carly Jane Waters
• Jackson Watson
• Kathryn L Watson, RDN

• Rehabilitation Psychologist in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Rehabilitation Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.