MEDICARE: COLLEEN ELIZABETH RICE

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
2	1041C0700X	Clinical Social Worker	LW61193759	WA

General Provider Information

NPI Number	:	1588000277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN ELIZABETH RICE

Provider Business Mailing Address
First Line	:	2600 S EL CAMINO REAL
Second Line	:	STE 200
City	:	SAN MATEO
State	:	CA
Zip	:	94403-2380
Country	:	US
Telephone Number	:	650-578-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 OLD FAIRHAVEN PKWY STE 106
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-8266
Country	:	US
Telephone Number	:	360-788-8388
Fax Number	:	360-788-8389

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

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	08/08/2022

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