Endc PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

ENDC PLLC

Practice address

19217 36TH Ave W. Suite 219
Lynnwood, WA 98036

Phone

(425) 753-5001

Fax

(425) 412-3960

NPI assigned

Nov 12, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Nicole Marie Bain, PHD MA MED

Title

Psychologist/Owner

Phone

(425) 753-5001

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Nerodevelopmental Center Doing business as

Locations

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1881239028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 635",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "98275",
            "telephone_number": "425-753-5001",
            "fax_number": "425-412-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19217 36TH AVE W. SUITE 219",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "98036",
            "telephone_number": "425-753-5001",
            "fax_number": "425-412-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "BAIN",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "425-753-5001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD MA MED"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Nerodevelopmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; 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.