Healthcare Provider Details

I. General information

NPI: 1245347053
Provider Name (Legal Business Name): JAMES FREDRICK RODMAN LMFT, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4589 UPPER HARBOR DR STE 100
FREELAND WA
98249-9422
US

IV. Provider business mailing address

4589 UPPER HARBOR DR STE 100
FREELAND WA
98249-9422
US

V. Phone/Fax

Practice location:
  • Phone: 360-325-8992
  • Fax:
Mailing address:
  • Phone: 360-325-8992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number275
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61180612
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number514
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: