Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor |
NPI | 1003302266 |
---|---|
Provider Name | Andrew Severtsen |
First Address | Seattle, WA 98121-2385 |
Second Address | Seattle, WA 98121-2385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 21/05/2021 |