Healthcare Provider Details

I. General information

NPI: 1063804425
Provider Name (Legal Business Name): SUSANNAH GRACE DAY MED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANNAH GRACE MILNER LMHC

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 KEENE RD BLDG G
RICHLAND WA
99352-7752
US

IV. Provider business mailing address

1950 KEENE RD BLDG G
RICHLAND WA
99352-7752
US

V. Phone/Fax

Practice location:
  • Phone: 509-619-0519
  • Fax: 888-482-2725
Mailing address:
  • Phone: 509-619-0519
  • Fax: 888-482-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7068
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number171745
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60801340
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: