Provider Demographics
NPI:1588614713
Name:RAE, CYNTHIA (LMHC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:RAE
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 1:1521 BOWMAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4604
Mailing Address - Country:US
Mailing Address - Phone:360-951-6674
Mailing Address - Fax:
Practice Address - Street 1:2938 LIMITED LN NW STE A-2
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6500
Practice Address - Country:US
Practice Address - Phone:360-951-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health