Provider Demographics
NPI:1568726040
Name:EIBEN, JOSEPH R (LMHC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:EIBEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 30TH AVE
Mailing Address - Street 2:APT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6228
Mailing Address - Country:US
Mailing Address - Phone:206-999-6408
Mailing Address - Fax:206-999-6408
Practice Address - Street 1:1633 BELLEVUE AVE
Practice Address - Street 2:UNIT A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6818
Practice Address - Country:US
Practice Address - Phone:206-999-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5814101YP2500X
WALH60512309101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional