Unknown Individual – Clinical Psychologist, NPI 1710062880

Unknown Individual is a healthcare provider. based in Snohomish, Washington. specializing in Clinical Psychologist. They hold a License No. PY00001438 (WA). The NPI Number for Unknown Individual is 1710062880

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710062880
Phone
(360) 568-8737
Address
1306B LAKE VIEW AVE
Deactivation Date
14 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3605688737
Graduation Year
1977 (49 years ago)
PAC ID
0244120616
Group Practice PAC ID
3375433741
Professional Enrollment ID
I20120312000662
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Lake View Avenue, Northwest Snohomish, Snohomish, Snohomish County, Washington, 98291, United States

    SNOHOMISH, WA 982901844

    Phone: (360) 568-8737

    Fax: (360) 568-1654

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98290)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3375433741View full group profile
NameSpecialtyState
Clinical Social WorkerKS
-WA
Mental Health CounselorWA
Clinical PsychologistWA
Clinical PsychologistWA
Mental Health CounselorWA
Clinical Social WorkerWA

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1710062880 as the unique 10-digit identifier.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Snohomish, Washington.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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