Provider Demographics
NPI:1144345828
Name:RANGE, WILLIAM (M ED, LMHC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RANGE
Suffix:
Gender:M
Credentials:M ED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 WASHINGTON ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-5741
Mailing Address - Country:US
Mailing Address - Phone:360-912-4741
Mailing Address - Fax:
Practice Address - Street 1:914 WASHINGTON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5741
Practice Address - Country:US
Practice Address - Phone:360-912-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00006474OtherWASHINGTON STATE LICENSE