Basic Information
| Provider Information | |||||||||
| NPI: | 1780184911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | MARK ANTHONY | ||||||||
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| Credential: | LMFT-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34703 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067640502 | ||||||||
| FaxNumber: | 2067640516 | ||||||||
| Practice Location | |||||||||
| Address1: | 6659 KIMBALL DR STE C301 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983355139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532809888 | ||||||||
| FaxNumber: | 2534324959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2018 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MG60828426 | WA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.