Thomas A Fossedal, BA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

61600 Issued in WA

Practice address

7727 46TH PL W
Mukilteo, WA 98275-2703

Phone

(425) 218-9771

NPI assigned

Apr 17, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Thomas A Fossedal Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492387200000",
    "number": "1144754029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7727 46TH PL W",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982752703",
            "telephone_number": "425-218-9771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7727 46TH PL W",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982752703",
            "telephone_number": "425-218-9771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSSEDAL",
        "first_name": "THOMAS",
        "middle_name": "A",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "61600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THOMAS",
            "last_name": "FOSSEDAL",
            "middle_name": "A",
            "credential": "BA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.