Healthcare Provider Details

I. General information

NPI: 1366974511
Provider Name (Legal Business Name): WANDA DAVIS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 S 148TH ST
TUKWILA WA
98168-4319
US

IV. Provider business mailing address

3438 S 148TH ST
TUKWILA WA
98168-4319
US

V. Phone/Fax

Practice location:
  • Phone: 206-832-8518
  • Fax:
Mailing address:
  • Phone: 206-832-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLH00008882
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00008882
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: