MEDICARE: MISS STEPHANIE LEANN RAINES NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	340179	OTHER	MS	NATIONAL BOARD FOR CERTIFIED COUNSELORS NBCC

General Provider Information

NPI Number	:	1598153017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE LEANN RAINES NCC

Provider Business Mailing Address
First Line	:	1612 TAMPA DR
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-1146
Country	:	US
Telephone Number	:	601-331-7833
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 TAMPA DR
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-1146
Country	:	US
Telephone Number	:	601-331-7833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/08/2015

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