Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY00002543 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY00002543 | WA |
Y | 103G00000X | Clinical Psychologist | PY00002543 | WA |
Y | 103TC0700X | Clinical Psychologist | PY00002543 | WA |
N | 103TC1900X | Counseling Psychologist | PY00002543 | WA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY00002543 | WA |
N | 103TF0000X | Family Psychologist | PY00002543 | WA |
N | 103TP2701X | Group Psychotherapist | PY00002543 | WA |
NPI | 1659521912 |
---|---|
Provider Name | Dr. Wayne E Carr |
First Address | Edmonds, WA 98026 |
Second Address | Kenmore, WA 98028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 12/01/2015 |