Provider Demographics
NPI:1548521404
Name:LENNON, JOHN WILLIAM (EDD, LMHC, SOTP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:LENNON
Suffix:
Gender:M
Credentials:EDD, LMHC, SOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 140TH AVE NE
Mailing Address - Street 2:STE E OR F
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2978
Mailing Address - Country:US
Mailing Address - Phone:425-454-0616
Mailing Address - Fax:425-637-1289
Practice Address - Street 1:1160 140TH AVE NE
Practice Address - Street 2:STE E OR F
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2978
Practice Address - Country:US
Practice Address - Phone:425-454-0616
Practice Address - Fax:425-637-1289
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health