Provider Demographics
NPI:1922509694
Name:WEIDENBORNER, DAVID (LMHC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WEIDENBORNER
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 1:11 3RD ST NW
Mailing Address - Street 2:#1421
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071
Mailing Address - Country:US
Mailing Address - Phone:206-395-4131
Mailing Address - Fax:
Practice Address - Street 1:32808 145TH PL SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-5976
Practice Address - Country:US
Practice Address - Phone:206-395-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61204561101YM0800X
NY009471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health