=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033452156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD WILLIAM SOLITAIRE MA, LMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2013
-----------------------------------------------------
Last Update Date | 05/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 S. PINE ST. 30-19
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-441-9883
-----------------------------------------------------
Fax | 877-346-2980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1641 S. HUSON DRIVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-441-9883
-----------------------------------------------------
Fax | 877-346-2980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LH60334940
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------