Provider Demographics
NPI:1922419571
Name:WEATHERBY, JOSEPH M (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:WEATHERBY
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10717 55TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2211
Mailing Address - Country:US
Mailing Address - Phone:206-348-5460
Mailing Address - Fax:
Practice Address - Street 1:3250 AIRPORT WAY S STE 420
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2167
Practice Address - Country:US
Practice Address - Phone:206-348-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LH60882062101YM0800X
WAMC 60385266103TC1900X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602327694OtherWA STATE BUSINESS LICENSE UBI NUMBER