Healthcare Provider Details

I. General information

NPI: 1417293473
Provider Name (Legal Business Name): GEOFFREY A RICHIE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 11TH AVE STE B
LONGVIEW WA
98632-2555
US

IV. Provider business mailing address

11335 NE 122ND WAY STE 105
KIRKLAND WA
98034-6933
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-8600
  • Fax: 360-636-7372
Mailing address:
  • Phone: 425-522-2282
  • Fax: 425-242-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH60620853
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: