Provider Demographics
NPI:1831359363
Name:WUNDER, LYNN ELISE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ELISE
Last Name:WUNDER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:ELISE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33442 1ST WAY S STE 101
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6210
Mailing Address - Country:US
Mailing Address - Phone:253-545-9129
Mailing Address - Fax:253-322-0295
Practice Address - Street 1:33442 1ST WAY S STE 101
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6222
Practice Address - Country:US
Practice Address - Phone:253-545-9129
Practice Address - Fax:253-322-0295
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60229718101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024838Medicaid