Basic Information
| Provider Information | |||||||||
| NPI: | 1730429010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMALL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOS 34703 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067643335 | ||||||||
| FaxNumber: | 2067648005 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 E COLLEGE WAY | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982735624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605428920 | ||||||||
| FaxNumber: | 3605428930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2013 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | RN00129990 | WA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.