James David Derr III, LHMCA
Individual provider Active NPI Mental Health Counselor · Snoqualmie, WA
NPI 1346968047 · NPPES record last updated Jan 27, 2023
Key facts
- NPI
- 1346968047
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- MC61267077 (WA)
- Practice address
- 9575 Ethan Wade Way SE
Snoqualmie, WA 98065-9577 - Phone
- (425) 831-5425
- Fax
- (425) 831-5428
- NPI assigned
- Aug 18, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC61267077 | WA | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC61267077 | WA | Yes |
Addresses
Primary practice location
9575 Ethan Wade Way SE
Snoqualmie, WA 98065-9577
Mailing address
3135 364TH Ave SE
Fall City, WA 98024-9428
Phone (832) 287-5124
Other practice location 1
3135 364th Ave SE
Fall City, WA 98024-9428
Phone (832) 287-5124
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2228264 | Medicaid | WA |
Other providers in Snoqualmie, WA
- Megan Christine Daniels
- David R. Primrose, DDS PLLC
- Casi Davis
- Amber Marie Deitering
- Madison L Dell
- Michel Aida Dill
- Ryan Michael Doolittle
- Karen Elizabeth Goodwin Douglass
- Anastasiya Dovzhenko
- Kelly Ann Dowell
All providers in Snoqualmie, WA · Mental Health Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.