# WASHINGTON STATE PSYCHOLOGICAL SERVICES, LLC

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

## Provider details

- **NPI number:** 1801130976
- **Authorized official:** DR. BRENDA HAVELLANA PHD (NEUROPSYCHOLOGIST)
- **Authorized official phone:** (425) 387-6972

## Contact information

- **Practice address:** 5105 200TH ST SW STE 100, LYNNWOOD, WA 98036-6397
- **Practice address phone:** (425) 387-6972
- **Practice address fax:** (425) 377-0701
- **Mailing address:** 3224 75TH DR NE, MARYSVILLE, WA 98270-6804
- **Mailing address phone:** (425) 387-6972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TR0400X | Rehabilitation Psychologist | PY60014648 | WA | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 11/15/2012