Active NPI
Ryan J Trudeau
- Mental Health Counselor
- Lynnwood, WA
National Provider Identifier
1174370373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 50004785
- Practice address
- 2525 202ND PL SW
Lynnwood, WA 98036-6955 - Phone
- (360) 808-7761
- NPI assigned
- May 4, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 50004785 | WA | Primary |
Addresses
Primary practice location
2525 202ND PL SW
Lynnwood, WA 98036-6955
Mailing address
2525 202ND PL SW
Lynnwood, WA 98036-6955
Phone (360) 808-7761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50004785 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714780800000",
"number": "1174370373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 202ND PL SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980366955",
"telephone_number": "360-808-7761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 202ND PL SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980366955",
"telephone_number": "360-808-7761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUDEAU",
"first_name": "RYAN",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-04",
"last_updated": "2024-05-04",
"certification_date": "2024-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "50004785",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.