Provider Demographics
NPI:1083058796
Name:LOMBARD, MICHAEL (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOMBARD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19807 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7782
Mailing Address - Country:US
Mailing Address - Phone:206-316-0701
Mailing Address - Fax:
Practice Address - Street 1:23607 HIGHWAY 99 STE 3D
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9272
Practice Address - Country:US
Practice Address - Phone:206-316-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60496372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist