1104926708 NPI number — MRS. LINDA SUE KUICK MED LMHC NBCC CCJTS

Table of content: MRS. LINDA SUE KUICK MED LMHC NBCC CCJTS (NPI 1104926708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104926708 NPI number — MRS. LINDA SUE KUICK MED LMHC NBCC CCJTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUICK
Provider First Name:
LINDA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED LMHC NBCC CCJTS
Provider Gender Code:
F

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:
1104926708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 BRADLEY BLVD
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-4498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-371-9956
Provider Business Mailing Address Fax Number:
509-371-9957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 BRADLEY BLVD
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-4498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-371-9956
Provider Business Practice Location Address Fax Number:
509-371-9957
Provider Enumeration Date:
09/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH00003555 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: LH00003555 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 26508 . This is a "CLINICALLY CERTIFIED JUVENILE TREATMENT SPECIALIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 51861 . This is a "NATIONAL BOARD CERTIFICAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: LH00003555 . This is a "STATE LICENSURE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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