Basic Information
| Provider Information | |||||||||
| NPI: | 1063819175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KURDIEH | ||||||||
| FirstName: | IBRAHIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2621 NE 134TH ST | ||||||||
| Address2: | STE 340 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986863036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604500140 | ||||||||
| FaxNumber: | 8773430535 | ||||||||
| Practice Location | |||||||||
| Address1: | 945 11TH AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604148600 | ||||||||
| FaxNumber: | 3606367372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2014 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY 60523286 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.