Provider Demographics
NPI:1861648537
Name:LANDERS, FRED (PHD, LMHC, LCAT)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:LANDERS
Suffix:
Gender:M
Credentials:PHD, LMHC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 BOREN AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1904
Mailing Address - Country:US
Mailing Address - Phone:206-643-0970
Mailing Address - Fax:
Practice Address - Street 1:305 HARRISON ST FL 4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4623
Practice Address - Country:US
Practice Address - Phone:206-643-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000946-01101200000X
WALH60482845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist