MEDICARE: LANI ANN KISH BS

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	101YM0800X	Mental Health Counselor	LH61152575	WA

General Provider Information

NPI Number	:	1568970721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANI ANN KISH BS

Provider Business Mailing Address
First Line	:	6626 WAGNER WAY STE 200
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-6904
Country	:	US
Telephone Number	:	253-858-2224
Fax Number	:	253-858-2254

Provider Business Practice Location Address
First Line	:	6626 WAGNER WAY STE 200
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-6904
Country	:	US
Telephone Number	:	253-858-2224
Fax Number	:	253-858-2254

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

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	07/19/2021

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