MEDICARE: JAMES FREDRICK RODMAN LMFT, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	275	CO
2	106H00000X	Marriage & Family Therapist	157	WY
3	106H00000X	Marriage & Family Therapist	LF61180612	WA
4	106H00000X	Marriage & Family Therapist	514	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LF61180612	OTHER	WA	LMFT
2	157	OTHER	WY	LMFT
3	514	OTHER	CO	LMFT
4	275	OTHER	CO	LAC

General Provider Information

NPI Number	:	1245347053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES FREDRICK RODMAN LMFT, LAC

Provider Business Mailing Address
First Line	:	4589 UPPER HARBOR DR STE 100
Second Line	:
City	:	FREELAND
State	:	WA
Zip	:	98249-9422
Country	:	US
Telephone Number	:	360-325-8992
Fax Number	:

Provider Business Practice Location Address
First Line	:	4589 UPPER HARBOR DR STE 100
Second Line	:
City	:	FREELAND
State	:	WA
Zip	:	98249-9422
Country	:	US
Telephone Number	:	360-325-8992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/25/2021

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