Anne Theresa Bornholdt
Individual provider Active NPI Mental Health Counselor · Sequim, WA
NPI 1669114237 · NPPES record last updated Apr 12, 2022
Key facts
- NPI
- 1669114237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- MC61236741 (WA)
- Practice address
- 302 Secor Rd
Sequim, WA 98382-9720 - Phone
- (360) 774-6904
- NPI assigned
- Apr 12, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 1, 2025 through May 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC61236741 | WA | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC61236741 | WA | Yes |
Addresses
Primary practice location
302 Secor Rd
Sequim, WA 98382-9720
Mailing address
302 Secor Rd
Sequim, WA 98382-9720
Phone (360) 774-6904
Other providers in Sequim, WA
- Megan Elizabeth Bland
- Brandie Blankenbaker
- Douglas G Blessington
- Chad C Boehm
- Molly Rhea Booth
- Michael L Boucher
- Boyack & Despain PLLC
- Braden Partners LP
- Bradi Bergesen Counseling PLLC
- Joseph Edwin Brenner
All providers in Sequim, 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 Apr 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.