MEDICARE: ERIC STROM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60458796	WA

General Provider Information

NPI Number	:	1912359555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC STROM

Provider Business Mailing Address
First Line	:	13229 2ND AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98177-4004
Country	:	US
Telephone Number	:	206-295-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8011
Country	:	US
Telephone Number	:	206-295-0076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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Directions to “ ERIC STROM ” Practice Location

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