1912626953 NPI number — PRISMATIC COUNSELING, PLLC

Table of content: LINDSAY ORRINGER LIBEN LMSW (NPI 1144654229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912626953 NPI number — PRISMATIC COUNSELING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRISMATIC COUNSELING, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912626953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 SE LUND AVE # 1046
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-5555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-504-3203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5319 BETHEL RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98367-7827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-504-3203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
ELLIOT
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
206-504-3203

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1912626953 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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