Provider Demographics
NPI:1952068462
Name:KRAETSCH, JOSHUA (LMHC-A)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:KRAETSCH
Suffix:
Gender:M
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1421
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-1421
Mailing Address - Country:US
Mailing Address - Phone:507-421-3458
Mailing Address - Fax:
Practice Address - Street 1:112 KALA SQUARE PL STE 2
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9810
Practice Address - Country:US
Practice Address - Phone:360-390-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61232881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health