Provider Demographics
NPI:1295204287
Name:KETOLA, DAVID (LMHCA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KETOLA
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N 179TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4727
Mailing Address - Country:US
Mailing Address - Phone:206-401-4639
Mailing Address - Fax:
Practice Address - Street 1:1539 NE 177TH ST STE B
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5279
Practice Address - Country:US
Practice Address - Phone:206-401-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60904560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health