Provider Demographics
NPI:1417057100
Name:LARAE, ANITA L (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:L
Last Name:LARAE
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 236
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98353-0236
Mailing Address - Country:US
Mailing Address - Phone:360-871-4431
Mailing Address - Fax:360-769-5909
Practice Address - Street 1:4275 SE MILE HILL DR
Practice Address - Street 2:SUITE B
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3934
Practice Address - Country:US
Practice Address - Phone:360-871-4431
Practice Address - Fax:360-769-5909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00046731101YM0800X
WALH00010789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health