Healthcare Provider Details

I. General information

NPI: 1710245576
Provider Name (Legal Business Name): MR. EYVIND HAMMERSMARK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EYVIND HAMMERSMARK LMFT

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 NE 185TH ST
BOTHELL WA
98011-3437
US

IV. Provider business mailing address

10309 NE 185TH ST
BOTHELL WA
98011-3437
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-6541
  • Fax: 425-485-4154
Mailing address:
  • Phone: 425-485-6541
  • Fax: 425-485-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005556
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF 00001457
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: