Provider Demographics
NPI:1801442926
Name:IINO, ROGER EDWIN (LMHC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:EDWIN
Last Name:IINO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14704 27TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7415
Mailing Address - Country:US
Mailing Address - Phone:206-351-5265
Mailing Address - Fax:
Practice Address - Street 1:5801 23RD DR W STE 104
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1587
Practice Address - Country:US
Practice Address - Phone:425-513-8213
Practice Address - Fax:425-513-0534
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health