Basic Information
| Provider Information | |||||||||
| NPI: | 1003265711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMOKEL | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JAMES | ||||||||
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| OtherLastName: | SCHMOKEL | ||||||||
| OtherFirstName: | ANDY | ||||||||
| OtherMiddleName: | JAMES | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4038 ROCK MAPLE LN NW | ||||||||
| Address2: | APT 202 | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985026810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604208759 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3214 W MCGRAW ST | ||||||||
| Address2: | STE 212 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981993239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064534882 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2016 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | WA | N |
No ID Information.