Healthcare Provider Details

I. General information

NPI: 1639247752
Provider Name (Legal Business Name): DAVID JAMES CUDWORTH LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 89TH PL NE
KENMORE WA
98028-4766
US

IV. Provider business mailing address

14810 89TH PL NE
KENMORE WA
98028-4766
US

V. Phone/Fax

Practice location:
  • Phone: 425-381-6895
  • Fax:
Mailing address:
  • Phone: 425-349-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: