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General NPI Number Information
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NPI Number | 1710330824
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Entity Type | Individual
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Provider Name | GENISE RACHELLE BAGBY MA, LMHC, SUDP, DVIT
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Gender | Female
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 15 S GRADY WAY STE 610
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City | RENTON
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State | WA
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Zip | 98057-3218
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Country | US
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Telephone | 206-679-8291
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Fax | 206-274-6252
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Provider Business Mailing Address
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Address Line | 15 S GRADY WAY STE 610
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City | RENTON
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State | WA
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Zip | 98057-3218
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Country | US
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Telephone | 206-679-8291
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Fax | 206-274-6252
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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 | LH60844525
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CO60705270
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License Number State | WA
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