Provider Demographics
NPI:1295003069
Name:MADIAN, LORAINE GISELE (LMHC)
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:GISELE
Last Name:MADIAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-0466
Mailing Address - Country:US
Mailing Address - Phone:541-490-1786
Mailing Address - Fax:
Practice Address - Street 1:732 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-1665
Practice Address - Country:US
Practice Address - Phone:541-490-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60239321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health