Basic Information
| Provider Information | |||||||||
| NPI: | 1770237612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUND HEART PSYCHOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 CATON WAY SW | ||||||||
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| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985021105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609514009 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 CATON WAY SW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985021105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609514009 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2022 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | O'NEIL | ||||||||
| AuthorizedOfficialFirstName: | MOLLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3609514009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.