Healthcare Provider Details

I. General information

NPI: 1205531563
Provider Name (Legal Business Name): DANIEL KUZMYCZ LMHC, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N 10TH PL
RENTON WA
98057-0009
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 425-391-5700
  • Fax: 425-391-5701
Mailing address:
  • Phone: 206-320-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH70104903
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: