Provider Demographics
NPI:1104375443
Name:CRICHTON, ITALIA
Entity Type:Individual
Prefix:
First Name:ITALIA
Middle Name:
Last Name:CRICHTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 S 148TH ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4319
Mailing Address - Country:US
Mailing Address - Phone:206-832-8518
Mailing Address - Fax:
Practice Address - Street 1:3438 S 148TH ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4319
Practice Address - Country:US
Practice Address - Phone:206-832-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2021-12-14
Deactivation Date:2021-10-14
Deactivation Code:
Reactivation Date:2021-12-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor