Provider Demographics
NPI:1508809849
Name:VIDAN, TED (LMFT)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:VIDAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29633 MARINE VIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3400
Mailing Address - Country:US
Mailing Address - Phone:253-945-1004
Mailing Address - Fax:253-945-1004
Practice Address - Street 1:29633 MARINE VIEW DR SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-3400
Practice Address - Country:US
Practice Address - Phone:253-945-1004
Practice Address - Fax:253-945-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA216458OtherMHN