Healthcare Provider Details

I. General information

NPI: 1306145651
Provider Name (Legal Business Name): RAINIER COUNSELING AND SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 BLAKE ST
ENUMCLAW WA
98022-9382
US

IV. Provider business mailing address

847 BLAKE ST
ENUMCLAW WA
98022-9382
US

V. Phone/Fax

Practice location:
  • Phone: 360-802-0446
  • Fax: 360-802-0449
Mailing address:
  • Phone: 360-802-0446
  • Fax: 360-802-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. MELISSA ANN LATHUM
Title or Position: CDPT/OWNER
Credential:
Phone: 360-802-0446