# LISA A JUNGCLAS PH D INC

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

## Provider details

- **NPI number:** 1508099060
- **Authorized official:** LORI PETERS (OFFICE MANAGER)
- **Authorized official phone:** (360) 734-7310

## Contact information

- **Practice address:** 12 BELLWETHER WAY STE 220, BELLINGHAM, WA 98225-2914
- **Practice address phone:** (360) 734-7310
- **Practice address fax:** (360) 647-8336
- **Mailing address:** 12 BELLWETHER WAY, STE 220, BELLINGHAM, WA 98225
- **Mailing address phone:** (360) 734-7310
- **Mailing address fax:** (360) 647-8336

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | PY00002518 | WA | Yes |

## Other

- **Enumeration date:** 09/01/2009
- **Last updated:** 11/30/2012