Provider Demographics
NPI:1619215803
Name:RADETSKI, SCOTT (LMHCA, M-DIV)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:RADETSKI
Suffix:
Gender:M
Credentials:LMHCA, M-DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20595 HWY 305NE
Mailing Address - Street 2:ALLIES MILITARY MINISTRY
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9019
Mailing Address - Country:US
Mailing Address - Phone:360-536-2824
Mailing Address - Fax:
Practice Address - Street 1:18657 ST HWY 305 NE
Practice Address - Street 2:SUITE 114
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8418
Practice Address - Country:US
Practice Address - Phone:360-536-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60187578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health