Individual
MR. VINCENT THOMAS GOLLOGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
11444 GRAVELLY LAKE DR SW, LAKEWOOD, WA 98499-1404
(253) 223-2525
Mailing address
11444 GRAVELLY LAKE DR SW, LAKEWOOD, WA 98499-1404
(253) 223-2525
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY00002233
WA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PY00002233
WA
Other
Enumeration date
08/14/2015
Last updated
08/14/2015
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