Provider Demographics
NPI:1932547601
Name:CALVERT, DAVID F (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:F
Last Name:CALVERT
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 KAPALEA WAY SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2182
Mailing Address - Country:US
Mailing Address - Phone:360-701-6469
Mailing Address - Fax:
Practice Address - Street 1:1570 N NATIONAL AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2215
Practice Address - Country:US
Practice Address - Phone:360-704-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60040897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603278820OtherUNIFORM BUSINESS IDENTIFICATION
WA46-2158653OtherEMPLOYER IDENTIFICATION NUMBER (IRS)