Provider Demographics
NPI:1548620792
Name:FRED, VERMEDA (MFT)
Entity type:Individual
Prefix:
First Name:VERMEDA
Middle Name:
Last Name:FRED
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E SUNSET DR
Mailing Address - Street 2:SUITE 145, #517
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3597
Mailing Address - Country:US
Mailing Address - Phone:415-518-4321
Mailing Address - Fax:
Practice Address - Street 1:1715 C ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4016
Practice Address - Country:US
Practice Address - Phone:415-518-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60078860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist