Provider Demographics
NPI:1851081764
Name:RASMUSSEN, LUCIELEN MACIEL
Entity Type:Individual
Prefix:
First Name:LUCIELEN
Middle Name:MACIEL
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 N. HAMILTON
Mailing Address - Street 2:
Mailing Address - City:ST. SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99920
Mailing Address - Country:US
Mailing Address - Phone:360-240-0022
Mailing Address - Fax:866-240-0809
Practice Address - Street 1:1720 N. HAMILTON
Practice Address - Street 2:
Practice Address - City:ST. SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99920
Practice Address - Country:US
Practice Address - Phone:360-240-0022
Practice Address - Fax:866-240-0809
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician