Provider Demographics
NPI:1952606220
Name:RENTON FAMILY THERAPY
Entity Type:Organization
Organization Name:RENTON FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ADDARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:206-877-3188
Mailing Address - Street 1:306 WELLS AVE S
Mailing Address - Street 2:UNIT A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2785
Mailing Address - Country:US
Mailing Address - Phone:206-877-3188
Mailing Address - Fax:206-400-1142
Practice Address - Street 1:306 WELLS AVE S
Practice Address - Street 2:UNIT A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2785
Practice Address - Country:US
Practice Address - Phone:206-877-3188
Practice Address - Fax:206-400-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health