=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245603570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENA CHINN LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2015
-----------------------------------------------------
Last Update Date | 11/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10650 NE 9TH PL #1920
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-395-4022
-----------------------------------------------------
Fax | 425-452-8802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10650 NE 9TH PL #1920
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-395-4022
-----------------------------------------------------
Fax | 425-452-8802
-----------------------------------------------------
=====================================================
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 | 60568725
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------