Provider Demographics
NPI:1982007464
Name:DEWAELSCHE, DANIEL LEE (MA, MHC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:DEWAELSCHE
Suffix:
Gender:M
Credentials:MA, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 S 47TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4452
Mailing Address - Country:US
Mailing Address - Phone:253-475-9442
Mailing Address - Fax:253-475-9452
Practice Address - Street 1:3516 S 47TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4452
Practice Address - Country:US
Practice Address - Phone:253-475-9442
Practice Address - Fax:253-475-9452
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60153708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health