Healthcare Provider Details

I. General information

NPI: 1366953390
Provider Name (Legal Business Name): RENA KAY THOMPSON CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YAKIMA AVE STE 14
TACOMA WA
98405-4869
US

IV. Provider business mailing address

PO BOX 5242
TACOMA WA
98415-0242
US

V. Phone/Fax

Practice location:
  • Phone: 253-267-5402
  • Fax: 253-328-7301
Mailing address:
  • Phone: 253-433-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number60935291
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60801891
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: