Provider Demographics
NPI:1346837853
Name:HENDRICKS, NATASHA RENEE (LMHCA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENEE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LMHCA
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 188
Mailing Address - Street 2:
Mailing Address - City:HUSUM
Mailing Address - State:WA
Mailing Address - Zip Code:98623-0188
Mailing Address - Country:US
Mailing Address - Phone:253-332-1113
Mailing Address - Fax:
Practice Address - Street 1:868 HWY 141
Practice Address - Street 2:
Practice Address - City:HUSUM
Practice Address - State:WA
Practice Address - Zip Code:98623
Practice Address - Country:US
Practice Address - Phone:253-332-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61124079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMHCA.MC.61124079OtherWA DOH