Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 911180810 | WA |
NPI | 1073919932 |
---|---|
Provider Name | Mr. Gregory Maxwell |
First Address | Everett, WA 98203-2132 |
Second Address | Everett, WA 98203-2132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2014 |
Last Update Date | 05/11/2014 |