Doctor Name: | LORAINE GISELE MADIAN |
NPI Number: | 1295003069 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | LH 60239321 |
Business Practice Address: | 732 Ne 2nd Ave Camas, WA - 986071665 |
Business Phone Number: | 5414901786 |
Business Fax Number: | |
Mailing Address: | Po Box 466, CAMAS |
State: | WA |
Postal Code: | 986070466 |
Phone Number: | 5414901786 |
Fax Number: | |
NPI Enumeration Date: | 12/08/2011 |
NPI Last Update Date: | 06/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH 60239321 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |