Healthcare Provider Details

I. General information

NPI: 1457666836
Provider Name (Legal Business Name): MANIVONG JAMES RATTS PHD, LMHC, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE STE 701
SEATTLE WA
98104-3508
US

IV. Provider business mailing address

4310 89TH AVE SE
MERCER ISLAND WA
98040-4132
US

V. Phone/Fax

Practice location:
  • Phone: 206-202-0040
  • Fax: 206-323-3687
Mailing address:
  • Phone: 206-409-0885
  • Fax: 206-323-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60691191
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: