Provider Demographics
NPI:1104218163
Name:GREENWOOD, DAVID (MA, MS, CCH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:MA, MS, CCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 NE 1ST ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3049
Mailing Address - Country:US
Mailing Address - Phone:425-214-7450
Mailing Address - Fax:425-214-7301
Practice Address - Street 1:11900 NE 1ST ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3049
Practice Address - Country:US
Practice Address - Phone:425-214-7450
Practice Address - Fax:425-214-7301
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-28
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHP60519284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health