Healthcare Provider Details

I. General information

NPI: 1023428117
Provider Name (Legal Business Name): ANTHONIE ONTREAY ETIENNE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 9TH ST SW STE 205
PUYALLUP WA
98373-5946
US

IV. Provider business mailing address

PO BOX 731915
PUYALLUP WA
98373-0045
US

V. Phone/Fax

Practice location:
  • Phone: 760-881-5559
  • Fax: 442-255-1126
Mailing address:
  • Phone: 442-348-3822
  • Fax: 442-255-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61658464
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT138474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: