DR. GARY DANIEL SOUTHWELL (NPI# 1538235908) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538235908 |
| Entity Type | Individual |
| Full Name | DR. GARY DANIEL SOUTHWELL |
| Credential | PH.D. |
| Practice Address |
9643 39th Loop Ne Olympia WA 98516-6230 |
| Practice Telephone | 3609518647 |
| Mailing Telephone | 3609518647 |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2016-10-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | PY 60423359 | WA | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
1655 | AZ | Behavioral Health & Social Service Providers |
| Street Address |
9643 39TH LOOP NE |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98516-6230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730744210 | Michael Oropeza | Behavioral Analyst | 8282 28th Court Northeast, Suite A, Lacey, WA 98516 | 2019-05-09 |
| 1902361330 | Amanda Jessica Mae Allen | Behavioral Analyst | Basics Nw LLC, 8282 28th Ct Ne Suite A, Lacey, WA 98516 | 2019-02-11 |
| 1619459393 | Kayla-renee Williams | Behavioral Analyst | Basics Nw LLC 8282 28th Ct Ne, Suite A, Lacey, WA 98516 | 2018-08-30 |
| 1174004303 | Julie Ann Lisowski | Massage Therapist | 3532 Cuddy Ln Ne, Lacey, WA 98516 | 2018-08-26 |
| 1740700145 | Joseph Brandon Kimmel | Denturist | 5032 Beverly Dr Ne, Olympia, WA 98516 | 2017-06-27 |
| 1649649880 | Katie Cole | Behavioral Analyst | 8282 28th Ct Ne, Suite A, Basics Nw, LLC, Lacey, WA 98516 | 2015-09-17 |
| 1306234166 | Reza Tahernia | Dentist | 8050 Freedon Lane Ne, Suite C, Lacey, WA 98516 | 2015-01-02 |
| 1770997603 | Qualified Surgical Services Pllc | Surgery | 3697 Cameron Dr Ne, Lacey, WA 98516 | 2014-06-18 |
| 1184048688 | Stephanie Renee Hjortedal | Specialist/Technologist | 8750 Tallon Lane Ne., Lacey, WA 98516 | 2014-02-05 |
| 1295169811 | Teasha Corrado | Behavioral Analyst | 8282 28th Court Ne, Suite A, Lacey, WA 98516 | 2013-08-30 |
| Find all providers in zip 98516 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194793737 | John Bradford Powell | Clinical Neuropsychologist | 2118 Caton Way Sw, Olympia, WA 98502 | 2006-03-09 |
| 1174796833 | South Sound Neuropsychology Inc. | Clinical Neuropsychologist | 108 22nd Ave Sw, Suite 14, Olympia, WA 98501-2871 | 2008-04-02 |
| 1477601789 | Kristine Rae Vandermark Powell | Clinical Neuropsychologist | 1800 Cooper Point Rd Sw, Bldg 17, Olympia, WA 98502-1178 | 2007-01-05 |
| 1154408383 | Howard A. Lloyd | Clinical Neuropsychologist | 108 22nd Ave Sw, Suite 14, Olympia, WA 98501-2871 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841757010 | Corianne Raychael Lawrence | Clinical Neuropsychologist | 112 N 14th St, Selah, WA 98942-1713 | 2019-02-25 |
| 1588138333 | Mynd Group LLC | Clinical Neuropsychologist | 1066 View Ridge Dr, Oak Harbor, WA 98277-8265 | 2019-01-15 |
| 1588163208 | Johanah Y Kang | Clinical Neuropsychologist | 2013 South 19th Street, Tacoma, WA 98405 | 2018-02-08 |
| 1669850681 | Neuropsychological Services of The South Sound LLC | Clinical Neuropsychologist | 2620 R W Johnson Rd Sw Ste 204, Tumwater, WA 98512-6133 | 2015-05-11 |
| 1710372412 | Daniela Ferdico | Clinical Neuropsychologist | 2101 112th Ave Ne, Suite 100, Bellevue, WA 98004-2944 | 2015-03-31 |
| 1689069502 | Erica K Johnson | Clinical Neuropsychologist | 19000 33rd Ave W Ste 100, Lynnwood, WA 98036-4750 | 2015-03-30 |
| 1659776474 | Rodger Meinz | Clinical Neuropsychologist | 12712 Admiralty Way, B-101, Everett, WA 98204-5562 | 2014-10-23 |
| 1952704413 | Brad Tyson | Clinical Neuropsychologist | 12039 Ne 128th St Fl 3, Kirkland, WA 98034-3029 | 2014-09-29 |
| 1649694662 | Kelly L Crenshaw | Clinical Neuropsychologist | 12 Bellwether Way Ste 240, Bellingham, WA 98225-2959 | 2014-02-11 |
| 1508289299 | Neuropsychology and Cognitive Health | Clinical Neuropsychologist | 1808 Richards Rd #120, Bellevue, WA 98005-3982 | 2014-01-30 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. GARY DANIEL SOUTHWELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.