Provider Demographics
NPI:1619748134
Name:RED THUNDER, ARETHA RAY
Entity Type:Individual
Prefix:
First Name:ARETHA
Middle Name:RAY
Last Name:RED THUNDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARETHA
Other - Middle Name:RAY
Other - Last Name:RED THUNDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:622 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2202
Mailing Address - Country:US
Mailing Address - Phone:509-378-6517
Mailing Address - Fax:
Practice Address - Street 1:622 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2202
Practice Address - Country:US
Practice Address - Phone:509-378-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)