Provider Demographics
NPI:1952435745
Name:RUNNETTE, ALEXANDER CREIGHTON II (MA,LMHC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CREIGHTON
Last Name:RUNNETTE
Suffix:II
Gender:M
Credentials:MA,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 N TRIBAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7416
Mailing Address - Country:US
Mailing Address - Phone:360-426-7788
Mailing Address - Fax:
Practice Address - Street 1:561 N TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-7416
Practice Address - Country:US
Practice Address - Phone:360-426-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health