Active NPI
Donald Pederson
- Mental Health Counselor
- Everett, WA
National Provider Identifier
1457727455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CG 60162614
- Practice address
- 3322 Broadway
Everett, WA 98201-4425 - Phone
- (425) 349-8359
- NPI assigned
- Aug 13, 2015
- Sex
- Male
- Sole proprietor
- No
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 | CG 60162614 | WA | Primary |
Addresses
Primary practice location
3322 Broadway
Everett, WA 98201-4425
Mailing address
PO Box 3810
Everett, WA 98213-8810
Phone (425) 349-8359
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 |
|---|---|---|---|
| CG 60162614 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439424000000",
"number": "1457727455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3810",
"city": "EVERETT",
"state": "WA",
"postal_code": "982138810",
"telephone_number": "425-349-8359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3322 BROADWAY",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014425",
"telephone_number": "425-349-8359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "DONALD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-13",
"last_updated": "2015-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "CG 60162614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.