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General NPI Number Information
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NPI Number | 1245951086
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Entity Type | Individual
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Provider Name | RIIS WHITWORTH MPA
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Gender | Male
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 14115 AURORA AVE N
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City | SEATTLE
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State | WA
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Zip | 98133-6942
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Country | US
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Telephone | 206-335-7843
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Fax |
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Provider Business Mailing Address
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Address Line | 515 3RD AVE
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City | SEATTLE
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State | WA
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Zip | 98104-2304
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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 | 61347503
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA61630639
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License Number State | WA
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