Provider Demographics
NPI:1275692535
Name:EGGERT, TOM J (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:J
Last Name:EGGERT
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 NW MARKET ST
Mailing Address - Street 2:SUITE 315A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4030
Mailing Address - Country:US
Mailing Address - Phone:206-769-6377
Mailing Address - Fax:206-782-8194
Practice Address - Street 1:2208 NW MARKET ST
Practice Address - Street 2:SUITE 315A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4030
Practice Address - Country:US
Practice Address - Phone:206-769-6377
Practice Address - Fax:206-782-8194
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health