MEDICARE: DANELLE WHITMORE MA, LMFTA

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	106H00000X	Marriage & Family Therapist	MG60680025	WA

General Provider Information

NPI Number	:	1649689522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANELLE WHITMORE MA, LMFTA

Provider Business Mailing Address
First Line	:	710 ERICKSEN AVE NE STE 100
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2835
Country	:	US
Telephone Number	:	206-565-6460
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 ERICKSEN AVE NE STE 100
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2835
Country	:	US
Telephone Number	:	206-565-6460
Fax Number	:

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

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	07/21/2022

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