Individual
DR. GARY DANIEL SOUTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
9643 39TH LOOP NE, OLYMPIA, WA 98516-6230
(360) 951-8647
Mailing address
9643 39TH LOOP NE, OLYMPIA, WA 98516-6230
(360) 951-8647
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY 60423359
WA
103TC0700X
Clinical Psychologist
1655
AZ
Other
Enumeration date
11/28/2006
Last updated
10/31/2016
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