Provider Demographics
NPI:1336682996
Name:RAINE, MICHELLE (LMHC, CN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RAINE
Suffix:
Gender:F
Credentials:LMHC, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 NE 43RD ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5832
Mailing Address - Country:US
Mailing Address - Phone:425-224-6710
Mailing Address - Fax:
Practice Address - Street 1:1314 NE 43RD ST STE 209
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5832
Practice Address - Country:US
Practice Address - Phone:425-224-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60678958133N00000X
WALH60890017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist