1710294350 NPI number — MR. WILLIAM MARTIN KOHLMEYER

Table of content: MR. WILLIAM MARTIN KOHLMEYER (NPI 1710294350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710294350 NPI number — MR. WILLIAM MARTIN KOHLMEYER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHLMEYER
Provider First Name:
WILLIAM
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOHLMEYER
Provider Other First Name:
BILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710294350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22228 24TH AVE S
Provider Second Line Business Mailing Address:
K-76
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98198-6653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-870-9079
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22228 24TH AVE S
Provider Second Line Business Practice Location Address:
K-76
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-6653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-870-9079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2010

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: 101YM0800X , with the licence number:  LH00003699 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2047893 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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