Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1336 | HI |
N | 103TA0700X | Adult Development & Aging Psychologist | 1336 | HI |
Y | 103G00000X | Clinical Psychologist | 1336 | HI |
Y | 103TC0700X | Clinical Psychologist | 1336 | HI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1336 | HI |
N | 103TE1100X | Exercise & Sports Psychologist | 1336 | HI |
N | 103TF0000X | Family Psychologist | ||
N | 103TH0004X | Health Psychologist | 1336 | HI |
N | 103TP2701X | Group Psychotherapist | ||
N | 103TR0400X | Rehabilitation Psychologist | 1336 | HI |
NPI | 1205266384 |
---|---|
Provider Name | Dr. David Herzog |
First Address | Edmonds, WA 98026-8029 |
Second Address | Edmonds, WA 98026-8029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2013 |
Last Update Date | 01/02/2017 |