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General NPI Number Information
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NPI Number | 1861648537
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Entity Type | Individual
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Provider Name | FRED LANDERS PHD, LMHC, LCAT
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Gender | Male
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 305 HARRISON ST FL 4
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City | SEATTLE
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State | WA
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Zip | 98109-4623
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Country | US
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Telephone | 206-643-0970
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 BOREN AVE APT 309
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City | SEATTLE
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State | WA
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Zip | 98101-1904
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Country | US
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Telephone | 206-643-0970
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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 | 101200000X
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Taxonomy Name | Drama Therapist
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License Number | 000946-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60482845
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License Number State | WA
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