Basic Information
Provider Information | |||||||||
NPI: | 1053559708 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MONSON | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | PETER | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2633A PARKMONT LN SW | ||||||||
Address2: | STE F | ||||||||
City: | OLYMPIA | ||||||||
State: | WA | ||||||||
PostalCode: | 985021167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3608708744 | ||||||||
FaxNumber: | 3609964282 | ||||||||
Practice Location | |||||||||
Address1: | 2633A PARKMONT LN SW | ||||||||
Address2: | STE F | ||||||||
City: | OLYMPIA | ||||||||
State: | WA | ||||||||
PostalCode: | 985021167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3608708744 | ||||||||
FaxNumber: | 3603523289 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/02/2009 | ||||||||
LastUpdateDate: | 08/16/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY 00001768 | WA | N |   | Behavioral Health & Social Service Providers | Psychologist |   | 103TB0200X | PY 00001768 | WA | N |   | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PY 00001768 | WA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | PY 00001768 | WA | N |   | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC2200X | PY 00001768 | WA | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | PY 00001768 | WA | N |   | Behavioral Health & Social Service Providers | Psychologist | Family |
No ID Information.