Active NPI
Phengsavanh Sayadeth
- Counselor
- Vancouver, WA
National Provider Identifier
1699523316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG61447587
- Practice address
- 2502 E Fourth Plain Blvd
Vancouver, WA 98661-3965 - Phone
- (360) 831-0904
- Fax
- (360) 433-9917
- NPI assigned
- May 8, 2024
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG61447587 | WA | Primary |
Addresses
Primary practice location
2502 E Fourth Plain Blvd
Vancouver, WA 98661-3965
Mailing address
PO Box 34703
Seattle, WA 98124-1703
Phone (208) 764-0502
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 |
|---|---|---|---|
| CG61447587 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715126400000",
"number": "1699523316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34703",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981241703",
"telephone_number": "208-764-0502",
"fax_number": "206-764-0516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2502 E FOURTH PLAIN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986613965",
"telephone_number": "360-831-0904",
"fax_number": "360-433-9917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAYADETH",
"first_name": "PHENGSAVANH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-08",
"last_updated": "2024-05-08",
"certification_date": "2024-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG61447587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.