Healthcare Provider Details

I. General information

NPI: 1043788458
Provider Name (Legal Business Name): CASSANDRA RILEY LMHC/MHP, SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 S 336TH ST
FEDERAL WAY WA
98003-6348
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7444
  • Fax: 253-661-8631
Mailing address:
  • Phone: 253-833-7444
  • Fax: 253-661-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.60847368
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.61097218
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: