Provider Demographics
NPI:1386815256
Name:MERRIWETHER, GLEN P (MA, LMHC, CDP)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:P
Last Name:MERRIWETHER
Suffix:
Gender:M
Credentials:MA, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2479
Mailing Address - Country:US
Mailing Address - Phone:425-641-1999
Mailing Address - Fax:425-641-4069
Practice Address - Street 1:40 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2479
Practice Address - Country:US
Practice Address - Phone:425-641-1999
Practice Address - Fax:425-641-4069
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003052101YA0400X
WALH00006263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA752991932OtherFEDERAL TAX ID NUMBER