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General NPI Number Information
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NPI Number | 1417057100
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Entity Type | Individual
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Provider Name | ANITA L LARAE LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 4275 SE MILE HILL DR SUITE B
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City | PORT ORCHARD
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State | WA
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Zip | 98366-3934
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Country | US
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Telephone | 360-871-4431
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Fax | 360-769-5909
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | MANCHESTER
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State | WA
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Zip | 98353-0236
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Country | US
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Telephone | 360-871-4431
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Fax | 360-769-5909
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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 | RC00046731
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00010789
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License Number State | WA
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