Healthcare Provider Details

I. General information

NPI: 1891262606
Provider Name (Legal Business Name): ANDREA L FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NW GILMAN BLVD STE 200
ISSAQUAH WA
98027-5364
US

IV. Provider business mailing address

301 N GREENWOOD CIR APT 10
SEATTLE WA
98103-3035
US

V. Phone/Fax

Practice location:
  • Phone: 425-295-7697
  • Fax:
Mailing address:
  • Phone: 253-579-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: