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General NPI Number Information
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NPI Number | 1053493940
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Entity Type | Individual
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Provider Name | ITAMAR RICHMOND
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7825 N SOUND DR
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-7675
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Country | US
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Telephone | 800-903-7952
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 PEABODY ST
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City | BELLINGHAM
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State | WA
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Zip | 98225-1745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | RC00055494
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License Number State | WA
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