Provider Demographics
NPI:1548431794
Name:MARINEZ, RANDY (MS, LMHC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:MARINEZ
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 1ST AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1457
Mailing Address - Country:US
Mailing Address - Phone:206-343-5561
Mailing Address - Fax:
Practice Address - Street 1:811 1ST AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1457
Practice Address - Country:US
Practice Address - Phone:206-343-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH-3530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health