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General NPI Number Information
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NPI Number | 1497634547
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Entity Type | Individual
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Provider Name | LUCAS B FADEM
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Gender | Male
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 402 15TH AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372-3709
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Country | US
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Telephone | 253-697-5200
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Fax | 253-697-5200
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Provider Business Mailing Address
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Address Line | 4203 BROOKLYN AVE NE APT 95
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City | SEATTLE
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State | WA
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Zip | 98105-5910
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Country | US
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Telephone | 303-908-3676
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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 |
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License Number State | WA
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