Provider Demographics
NPI:1336370238
Name:EKLUND, NATHAN WILLIAM (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WILLIAM
Last Name:EKLUND
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 1:13506 54TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9545
Mailing Address - Country:US
Mailing Address - Phone:206-660-8596
Mailing Address - Fax:
Practice Address - Street 1:2804 GRAND AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3430
Practice Address - Country:US
Practice Address - Phone:206-660-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011117101YM0800X
MI6401013679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional