Provider Demographics
NPI:1386845147
Name:WOODARD, DAN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:WOODARD
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 1:444 NE RAVENNA BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8436
Mailing Address - Country:US
Mailing Address - Phone:425-891-6631
Mailing Address - Fax:
Practice Address - Street 1:444 NE RAVENNA BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8436
Practice Address - Country:US
Practice Address - Phone:425-891-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health