Healthcare Provider Details

I. General information

NPI: 1356269955
Provider Name (Legal Business Name): RIVELEA CITRON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

15600 NE 8TH ST STE B1118
BELLEVUE WA
98008-3927
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: