Provider Demographics
NPI:1679221279
Name:GENETIN, ALISHA L (LMHC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:L
Last Name:GENETIN
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 1:10038 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3502
Mailing Address - Country:US
Mailing Address - Phone:937-631-8104
Mailing Address - Fax:
Practice Address - Street 1:10038 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3502
Practice Address - Country:US
Practice Address - Phone:937-631-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61184342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health