Provider Demographics
NPI:1790383263
Name:FARISH, PHILIP JAMES (LMHC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:FARISH
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 1:1900 NW DOCK PL STE 4
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4846
Mailing Address - Country:US
Mailing Address - Phone:425-522-3074
Mailing Address - Fax:
Practice Address - Street 1:1900 NW DOCK PL STE 7
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4846
Practice Address - Country:US
Practice Address - Phone:425-522-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61429364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health