Provider Demographics
NPI:1013526896
Name:REARDON, SEAN ROBERT (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ROBERT
Last Name:REARDON
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33455 6TH AVE S STE 2C
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6074
Mailing Address - Country:US
Mailing Address - Phone:253-210-4230
Mailing Address - Fax:
Practice Address - Street 1:841 CENTRAL AVE N STE C100
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2016
Practice Address - Country:US
Practice Address - Phone:206-474-2318
Practice Address - Fax:206-695-7606
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)