Organization
GRANDE RONDE PSYCHIATRIC SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY ALLEN TRUDEL M.D. (PRESIDENT)
(360) 477-3298
Entity
Organization
Contact information
Practice address
435 W BELL ST, STE. B-1, SEQUIM, WA 98382-2916
(360) 477-3298
(360) 452-9584
Mailing address
1994 S BAGLEY CREEK RD, PORT ANGELES, WA 98362-7454
(360) 477-3298
(360) 452-9584
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
MD60053143
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0265930
LABOR AND INDUSTRIES
WA
05
—
113092
—
OR
Enumeration date
01/04/2013
Last updated
01/04/2013
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