Provider Demographics
NPI:1417293473
Name:RICHIE, GEOFFREY A (LMHC)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:A
Last Name:RICHIE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 NE 122ND WAY
Mailing Address - Street 2:STE 105
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6933
Mailing Address - Country:US
Mailing Address - Phone:425-522-2282
Mailing Address - Fax:425-242-8813
Practice Address - Street 1:945 11TH AVE STE B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2555
Practice Address - Country:US
Practice Address - Phone:360-414-8600
Practice Address - Fax:360-636-7372
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60620853101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072665Medicaid
7646990OtherAETNA