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General NPI Number Information
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NPI Number | 1346968047
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Entity Type | Individual
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Provider Name | JAMES DAVID DERR III LHMCA
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Gender | Male
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 9575 ETHAN WADE WAY SE
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City | SNOQUALMIE
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State | WA
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Zip | 98065-9577
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Country | US
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Telephone | 425-831-5425
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Fax | 425-831-5428
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Provider Business Mailing Address
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Address Line | 3135 364TH AVE SE
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City | FALL CITY
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State | WA
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Zip | 98024-9428
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Country | US
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Telephone | 832-287-5124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61267077
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License Number State | WA
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