=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831431972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE PFUNDHELLER MSW, CDP, LAICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2013
-----------------------------------------------------
Last Update Date | 07/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 E OLIVE ST SOUND MENTAL HEALTH
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-302-2200
-----------------------------------------------------
Fax | 206-302-2210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 5TH AVE PUBLIC HEALTH - JAIL HEALTH SERVICES
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-477-1715
-----------------------------------------------------
Fax | 206-296-0959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CP60278331
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SC60341784
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SC60341784
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------