Provider Demographics
NPI:1003025081
Name:RICHARDSON, LINDA RAE (LMFT, LMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RAE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 NE HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6834
Mailing Address - Country:US
Mailing Address - Phone:360-698-9197
Mailing Address - Fax:360-692-9454
Practice Address - Street 1:9962 LEVIN RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7720
Practice Address - Country:US
Practice Address - Phone:360-698-9197
Practice Address - Fax:360-692-9454
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005867101YM0800X
WALF00001377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist