Provider Demographics
NPI:1457666836
Name:RATTS, MANIVONG JAMES (PHD, NCC, LMHC)
Entity Type:Individual
Prefix:DR
First Name:MANIVONG
Middle Name:JAMES
Last Name:RATTS
Suffix:
Gender:M
Credentials:PHD, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 89TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4132
Mailing Address - Country:US
Mailing Address - Phone:206-409-0885
Mailing Address - Fax:206-323-3687
Practice Address - Street 1:901 BOREN AVENUE
Practice Address - Street 2:SUITE 1300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-409-0885
Practice Address - Fax:206-323-3687
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60691191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health