Provider Demographics
NPI:1558405456
Name:COON, RENA M (RN,LMHC,LMP)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:M
Last Name:COON
Suffix:
Gender:F
Credentials:RN,LMHC,LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-3623
Mailing Address - Country:US
Mailing Address - Phone:509-328-3341
Mailing Address - Fax:
Practice Address - Street 1:1803 W CHELAN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-3623
Practice Address - Country:US
Practice Address - Phone:509-328-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005566101YM0800X
WARN00104025163W00000X
WAMA00009259174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered174400000XOther Service ProvidersSpecialist