Healthcare Provider Details

I. General information

NPI: 1104926708
Provider Name (Legal Business Name): LINDA SUE KUICK MED LMHC NBCC CCJTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BRADLEY BLVD STE. 200
RICHLAND WA
99352-4498
US

IV. Provider business mailing address

404 BRADLEY BLVD STE. 200
RICHLAND WA
99352-4498
US

V. Phone/Fax

Practice location:
  • Phone: 509-371-9956
  • Fax: 509-371-9957
Mailing address:
  • Phone: 509-371-9956
  • Fax: 509-371-9957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00003555
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH00003555
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: