David Fagerholm, M.ED,MHP, LMHCA, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC 60612129 Issued in WA

Practice address

122 16TH Ave E
Seattle, WA 98112-5212

Phone

(206) 302-2700

NPI assigned

Sep 18, 2014

Last updated

Jul 22, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sound

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tukwila, WA
  • NPI 1780774950
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1841692084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E OLIVE ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981222735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125212",
            "telephone_number": "206-302-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGERHOLM",
        "first_name": "DAVID",
        "credential": "M.ED,MHP, LMHCA, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-18",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC 60612129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Marie Herbert Faeben, MD
• Alyssa Faella-Aversa, MSW, LICSW
• Faerland Terrace LLC
• Corey N Fagan, PH.D.
• Kevin Patrick Fagan, CRNA
• Paola Faggella, LMHC
• Richard Eliot Fagley, MD
• Shaeleen M Fagre, AU.D.
• Amy Susan Faherty, SLP
• Pamela D Fahey

• Mental Health Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.