Provider Demographics
NPI:1730224593
Name:BEDERAUX-CAYNE, JAMES EMERSON (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EMERSON
Last Name:BEDERAUX-CAYNE
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3702
Mailing Address - Country:US
Mailing Address - Phone:206-898-9366
Mailing Address - Fax:206-937-2085
Practice Address - Street 1:3618 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3702
Practice Address - Country:US
Practice Address - Phone:206-898-9366
Practice Address - Fax:206-937-2085
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20489183998116A002OtherTRICARE TEPRV NUMBER