Provider Demographics
NPI:1245455203
Name:BARRY, RACHAEL Y
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:Y
Last Name:BARRY
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 1:4301 S PINE ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7264
Mailing Address - Country:US
Mailing Address - Phone:253-301-5220
Mailing Address - Fax:253-301-5230
Practice Address - Street 1:4301 S PINE ST
Practice Address - Street 2:SUITE 21
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7264
Practice Address - Country:US
Practice Address - Phone:253-301-5220
Practice Address - Fax:253-301-5230
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00151409163WP0808X
WAAP60045383363LP0808X
WALH60171126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9659301Medicaid