Provider Demographics
NPI:1861961633
Name:MECUM, DAVID EDWARD (BA, BSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:MECUM
Suffix:
Gender:M
Credentials:BA, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 MARTIN WAY E STE A-105
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5048
Mailing Address - Country:US
Mailing Address - Phone:360-459-9603
Mailing Address - Fax:
Practice Address - Street 1:3773 MARTIN WAY E STE A-105
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5048
Practice Address - Country:US
Practice Address - Phone:360-459-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty