Healthcare Provider Details

I. General information

NPI: 1881267573
Provider Name (Legal Business Name): CAROLYN RACHELLE ROCHE LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN RACHELLE MERICLE-ROCHE LMHCA

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 NE 85TH ST STE 220
REDMOND WA
98052-3546
US

IV. Provider business mailing address

1855 TROSSACHS BLVD SE UNIT 2103
SAMMAMISH WA
98075-5928
US

V. Phone/Fax

Practice location:
  • Phone: 425-558-0558
  • Fax:
Mailing address:
  • Phone: 425-679-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61145037
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: