=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942740378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAINIER COMPASSIONATE COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2017
-----------------------------------------------------
Last Update Date | 06/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22216 SE 272ND ST
-----------------------------------------------------
City | MAPLE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98038-7420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-429-8031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22216 SE 272ND ST
-----------------------------------------------------
City | MAPLE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98038-7420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-429-8031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AMANDA JANE ROSENKOETTER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 425-413-8031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY60484482
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------