Healthcare Provider Details

I. General information

NPI: 1861648537
Provider Name (Legal Business Name): FRED LANDERS PHD, LMHC, LCAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 HARRISON ST FL 4
SEATTLE WA
98109-4623
US

IV. Provider business mailing address

1420 BOREN AVE APT 309
SEATTLE WA
98101-1904
US

V. Phone/Fax

Practice location:
  • Phone: 206-643-0970
  • Fax:
Mailing address:
  • Phone: 206-643-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number000946-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60482845
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: