Provider Demographics
NPI:1780184911
Name:VALDEZ, MARK ANTHONY (LMFT-A)
Entity Type:Individual
Prefix:
First Name:MARK ANTHONY
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0502
Mailing Address - Fax:206-764-0516
Practice Address - Street 1:6659 KIMBALL DR STE C301
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5139
Practice Address - Country:US
Practice Address - Phone:253-280-9888
Practice Address - Fax:253-432-4959
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60828426106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist