Provider Demographics
NPI:1538351135
Name:ESPRIT CORP
Entity type:Organization
Organization Name:ESPRIT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-265-1448
Mailing Address - Street 1:7106 FORD DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6482
Mailing Address - Country:US
Mailing Address - Phone:253-265-1448
Mailing Address - Fax:253-265-1448
Practice Address - Street 1:7106 FORD DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6482
Practice Address - Country:US
Practice Address - Phone:253-265-1448
Practice Address - Fax:253-265-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002742103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP32711Medicare UPIN
WAAB36788Medicare PIN