Healthcare Provider Details

I. General information

NPI: 1881253185
Provider Name (Legal Business Name): VANCE LEIGH WHIPPO LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17922 OXFORD DR
ARLINGTON WA
98223-4625
US

IV. Provider business mailing address

17922 OXFORD DR
ARLINGTON WA
98223-4625
US

V. Phone/Fax

Practice location:
  • Phone: 425-244-8092
  • Fax:
Mailing address:
  • Phone: 425-244-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60893201
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: