1417057100 NPI number — MS. ANITA L LARAE LMHC

Table of content: MS. ANITA L LARAE LMHC (NPI 1417057100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417057100 NPI number — MS. ANITA L LARAE LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARAE
Provider First Name:
ANITA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
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:
1417057100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98353-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-871-4431
Provider Business Mailing Address Fax Number:
360-769-5909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4275 SE MILE HILL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-3934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-871-4431
Provider Business Practice Location Address Fax Number:
360-769-5909
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:  RC00046731 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LH00010789 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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