Provider Demographics
NPI:1811291982
Name:SYVERTSEN, ANDREW (MA, LMHC, BCBA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:SYVERTSEN
Suffix:
Gender:M
Credentials:MA, LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 EASTLAKE AVE E STE 306
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3399
Mailing Address - Country:US
Mailing Address - Phone:206-612-1008
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 306
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3399
Practice Address - Country:US
Practice Address - Phone:206-612-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-07-3686103K00000X
WALH 60495187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst