Provider Demographics
NPI:1710294350
Name:KOHLMEYER, WILLIAM MARTIN
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARTIN
Last Name:KOHLMEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:KOHLMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LMHC
Mailing Address - Street 1:22228 24TH AVE S
Mailing Address - Street 2:K-76
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6653
Mailing Address - Country:US
Mailing Address - Phone:206-870-9079
Mailing Address - Fax:
Practice Address - Street 1:22228 24TH AVE S
Practice Address - Street 2:K-76
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6653
Practice Address - Country:US
Practice Address - Phone:206-870-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047893Medicaid