MEDICARE: RICHARD E VANDERLINDA M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LF00001661	WA

General Provider Information

NPI Number	:	1518036599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E VANDERLINDA M.A.

Provider Business Mailing Address
First Line	:	6123 51ST STREET CT W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98467-4124
Country	:	US
Telephone Number	:	253-564-4572
Fax Number	:	253-564-8091

Provider Business Practice Location Address
First Line	:	3501 S ORCHARD ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98466-6735
Country	:	US
Telephone Number	:	253-564-4572
Fax Number	:	253-564-8091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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