Provider Demographics
NPI:1215252606
Name:ANDERSON, DAVID LEE (LMHC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-0646
Mailing Address - Country:US
Mailing Address - Phone:360-794-1405
Mailing Address - Fax:360-794-1493
Practice Address - Street 1:17880 147TH ST SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1014
Practice Address - Country:US
Practice Address - Phone:360-794-1405
Practice Address - Fax:360-794-1493
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003963101YA0400X
WALH00005921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)