Healthcare Provider Details

I. General information

NPI: 1184318578
Provider Name (Legal Business Name): MR. LEVANDER ELDON MAERTENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 S 188TH ST STE 300
SEATAC WA
98188-5070
US

IV. Provider business mailing address

4040 S 188TH ST STE 300
SEATAC WA
98188-5070
US

V. Phone/Fax

Practice location:
  • Phone: 206-816-3253
  • Fax:
Mailing address:
  • Phone: 206-816-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number61506116
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number70186025
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: