MEDICARE: MR. FRED LANDERS PHD, LMHC, LCAT

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	101200000X	Drama Therapist	000946-01	NY
2	101YM0800X	Mental Health Counselor	LH60482845	WA

General Provider Information

NPI Number	:	1861648537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED LANDERS PHD, LMHC, LCAT

Provider Business Mailing Address
First Line	:	1420 BOREN AVE APT 309
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1904
Country	:	US
Telephone Number	:	206-643-0970
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 HARRISON ST FL 4
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-4623
Country	:	US
Telephone Number	:	206-643-0970
Fax Number	:

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	07/25/2022

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