Provider Demographics
NPI:1356838015
Name:WENDFELDT, LARISA ROSE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:ROSE
Last Name:WENDFELDT
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33405 30TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2723
Mailing Address - Country:US
Mailing Address - Phone:206-484-6666
Mailing Address - Fax:
Practice Address - Street 1:4555 DELRIDGE WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1379
Practice Address - Country:US
Practice Address - Phone:206-279-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60869534106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist