1598857104 NPI number — MR. ROBBIE RAE MCMANUS MS LMHC

Table of content: MR. ROBBIE RAE MCMANUS MS LMHC (NPI 1598857104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598857104 NPI number — MR. ROBBIE RAE MCMANUS MS LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMANUS
Provider First Name:
ROBBIE
Provider Middle Name:
RAE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS LMHC
Provider Gender Code:
M

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:
1598857104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
897 JUNIPER PT LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMANO IS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-419-3531
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SOUTH SECOND ST
Provider Second Line Business Practice Location Address:
COMPASS NORTH
Provider Business Practice Location Address City Name:
MT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-419-3500
Provider Business Practice Location Address Fax Number:
360-419-3535
Provider Enumeration Date:
09/29/2006

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:  IH0003986 , 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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