Provider Demographics
NPI:1316658024
Name:ZHVANETSKY, MAXIM MICHAEL (BS, MA, LMHCA)
Entity type:Individual
Prefix:
First Name:MAXIM
Middle Name:MICHAEL
Last Name:ZHVANETSKY
Suffix:
Gender:M
Credentials:BS, MA, LMHCA
Other - Prefix:
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:ZHVANETSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, MA, LMHCA
Mailing Address - Street 1:123 NW 36TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4959
Mailing Address - Country:US
Mailing Address - Phone:206-929-2410
Mailing Address - Fax:
Practice Address - Street 1:1820 12TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2438
Practice Address - Country:US
Practice Address - Phone:206-929-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61492432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health