Provider Demographics
NPI:1376210450
Name:ENSELMAN, RIVER R (LMHCA, MHP, MS, CN)
Entity Type:Individual
Prefix:
First Name:RIVER
Middle Name:R
Last Name:ENSELMAN
Suffix:
Gender:F
Credentials:LMHCA, MHP, MS, CN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:ENSELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 NE 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1026
Mailing Address - Country:US
Mailing Address - Phone:206-334-1911
Mailing Address - Fax:
Practice Address - Street 1:2103 S ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-3615
Practice Address - Country:US
Practice Address - Phone:206-437-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61334587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health