1629353040 NPI number — STEPHENIE K HANSEN-DEL RIO LMHC

Table of content: STEPHENIE K HANSEN-DEL RIO LMHC (NPI 1629353040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629353040 NPI number — STEPHENIE K HANSEN-DEL RIO LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN-DEL RIO
Provider First Name:
STEPHENIE
Provider Middle Name:
K
Provider Name Prefix Text:
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:
HANSEN
Provider Other First Name:
STEPHENIE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629353040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1412 SW 43RD ST
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-229-5025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1412 SW 43RD ST STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-226-0862
Provider Business Practice Location Address Fax Number:
425-272-2717
Provider Enumeration Date:
10/17/2011

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:  LH60476181 , 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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