Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1083082366 |
---|---|
Provider Name | Richard Mayne |
First Address | Tacoma, WA 98405-4571 |
Second Address | Tacoma, WA 98405-4571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 03/09/2015 |