Provider Demographics
NPI:1023428117
Name:ETIENNE, ANTHONIE ONTREAY (LMFT)
Entity type:Individual
Prefix:MR
First Name:ANTHONIE
Middle Name:ONTREAY
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:LMFT
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 731915
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0045
Mailing Address - Country:US
Mailing Address - Phone:442-348-3822
Mailing Address - Fax:442-255-1126
Practice Address - Street 1:3911 9TH ST SW STE 205
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5946
Practice Address - Country:US
Practice Address - Phone:760-881-5559
Practice Address - Fax:442-255-1126
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 103K00000X
WALF61658464106H00000X
CALMFT138474106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst