1386815256 NPI number — MR. GLEN P. MERRIWETHER MA, LMHC, CDP

Table of content: (NPI 1669739801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386815256 NPI number — MR. GLEN P. MERRIWETHER MA, LMHC, CDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRIWETHER
Provider First Name:
GLEN
Provider Middle Name:
P.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC, CDP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386815256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 LAKE BELLEVUE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005-2479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-641-1999
Provider Business Mailing Address Fax Number:
425-641-4069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 LAKE BELLEVUE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-641-1999
Provider Business Practice Location Address Fax Number:
425-641-4069
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CP00003052 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LH00006263 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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