Provider Demographics
NPI:1245347053
Name:RODMAN, JAMES FREDRICK (LMFT, LAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDRICK
Last Name:RODMAN
Suffix:
Gender:M
Credentials:LMFT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4589 UPPER HARBOR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9422
Mailing Address - Country:US
Mailing Address - Phone:360-325-8992
Mailing Address - Fax:
Practice Address - Street 1:4589 UPPER HARBOR DR STE 100
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9422
Practice Address - Country:US
Practice Address - Phone:360-325-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO275101YA0400X
WY157106H00000X
WALF61180612106H00000X
CO514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF61180612OtherLMFT
WY157OtherLMFT
CO514OtherLMFT
CO275OtherLAC