Basic Information
| Provider Information | |||||||||
| NPI: | 1295882090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTMAN | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LMHP & CDP & CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1216B 88TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985015714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607486696 | ||||||||
| FaxNumber: | 3607480627 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985324817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607486696 | ||||||||
| FaxNumber: | 3607480627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP00005555 | WA | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LH00009335 | WA | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | HP10001531 | WA | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.