Provider Demographics
NPI:1639337702
Name:EMINETH, ANNMARIE R (LMHC)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:R
Last Name:EMINETH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:EMINETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:260 KALA POINT DR STE 207
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368
Mailing Address - Country:US
Mailing Address - Phone:360-301-6318
Mailing Address - Fax:
Practice Address - Street 1:1136 WATER ST STE 113
Practice Address - Street 2:SUITE 301
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6728
Practice Address - Country:US
Practice Address - Phone:360-301-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH0008587101YM0800X
WALH00008587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2013730Medicaid