Provider Demographics
NPI:1790675122
Name:PACIFIC NORTHWEST PSYCHOLOGICAL SERVICES AND CONSULTING
Entity type:Organization
Organization Name:PACIFIC NORTHWEST PSYCHOLOGICAL SERVICES AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACHIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-625-3950
Mailing Address - Street 1:4428 65TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9507
Mailing Address - Country:US
Mailing Address - Phone:732-997-9974
Mailing Address - Fax:
Practice Address - Street 1:4428 65TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-9507
Practice Address - Country:US
Practice Address - Phone:732-997-9974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health