Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 364157H | WA |
NPI | 1073859179 |
---|---|
Provider Name | Mr. Maury Douthit JR. |
First Address | Bellevue, WA 98008-5432 |
Second Address | Bellevue, WA 98008-5432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2012 |
Last Update Date | 17/12/2012 |