# PUGET SOUND SENIOR PSYCHOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053769844
- **Authorized official:** DR. DAVID AGNOR PHD (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (360) 253-4912

## Contact information

- **Practice address:** 9340 NE 76TH ST, VANCOUVER, WA 98662-3721
- **Practice address phone:** (360) 253-4912
- **Practice address fax:** (360) 253-5170
- **Mailing address:** 9340 NE 76TH ST, VANCOUVER, WA 98662-3721
- **Mailing address phone:** (360) 253-4912
- **Mailing address fax:** (360) 253-5170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | PY1511 | WA | Yes |

## Other

- **Enumeration date:** 06/02/2016
- **Last updated:** 06/02/2016