Provider Demographics
NPI:1104975226
Name:FERNANDEZ, LETHA (LMHC, CDP, DDMHS)
Entity type:Individual
Prefix:
First Name:LETHA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMHC, CDP, DDMHS
Other - Prefix:
Other - First Name:LETHA
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, CDP, DDMHS
Mailing Address - Street 1:2503 CAMAS AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2226
Mailing Address - Country:US
Mailing Address - Phone:206-687-2863
Mailing Address - Fax:
Practice Address - Street 1:2503 CAMAS AVE NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056
Practice Address - Country:US
Practice Address - Phone:206-687-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60196695101YA0400X
WALH60245300101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor