Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY00000611 | WA |
N | 103TC0700X | Clinical Psychologist | PY00000611 | WA |
Y | 103G00000X | Clinical Psychologist | PY00000611 | WA |
Y | 103TC0700X | Clinical Psychologist | PY00000611 | WA |
N | 103TR0400X | Rehabilitation Psychologist | PY00000611 | WA |
NPI | 1518159516 |
---|---|
Provider Name | Dr. John T Lloyd |
First Address | Port Angeles, WA 98362-7438 |
Second Address | Sequim, WA 98382-3080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38066 | WORKERS COMP OF WA STATE (01) | WA |
7257603 | (05) | WA |
GAB02714 | (02) | WA |