=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083249163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH MARIE RINCON LMHCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2020
-----------------------------------------------------
Last Update Date | 03/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1818 E MERCER ST STE 101
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112-4689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-681-6270
-----------------------------------------------------
Fax | 206-321-7654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 NW 56TH ST
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-823-6170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | MC61043345
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------