Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY00001701 | WA |
Y | 103TC0700X | Clinical Psychologist | PY00001701 | WA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY00001701 | WA |
NPI | 1134262884 |
---|---|
Provider Name | Dr. James Robert Masson |
First Address | Olympia, WA 98502-1105 |
Second Address | Olympia, WA 98502-1105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 13/01/2009 |