Provider Demographics
NPI:1316413644
Name:ATCHISON, NICOLLE (LMFTA)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:
Last Name:ATCHISON
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4387
Mailing Address - Country:US
Mailing Address - Phone:425-306-2488
Mailing Address - Fax:
Practice Address - Street 1:1025 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2765
Practice Address - Country:US
Practice Address - Phone:425-271-5600
Practice Address - Fax:425-227-8926
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60879293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist