Healthcare Provider Details

I. General information

NPI: 1013487727
Provider Name (Legal Business Name): DAVE WOLTHAUSEN CD , LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP0000272
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60713496
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: