Healthcare Provider Details

I. General information

NPI: 1114507761
Provider Name (Legal Business Name): EVAN LAWSON LMHC INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N 35TH ST STE 208D
SEATTLE WA
98103-8870
US

IV. Provider business mailing address

4550 38TH AVE SW APT 4410
SEATTLE WA
98126-2768
US

V. Phone/Fax

Practice location:
  • Phone: 206-462-5830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: