Provider Demographics
NPI:1376165969
Name:WASHBURN, FRED ALDEAN (PHD, LPC, LMHC,)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:ALDEAN
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:PHD, LPC, LMHC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 84TH AVE STE B12
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-5338
Mailing Address - Country:US
Mailing Address - Phone:509-899-7199
Mailing Address - Fax:
Practice Address - Street 1:500 E 84TH AVE STE B12
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-5338
Practice Address - Country:US
Practice Address - Phone:509-899-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60867259101YM0800X
COLPC.0015656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health