Basic Information
| Provider Information | |||||||||
| NPI: | 1740651918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARUAH | ||||||||
| FirstName: | ANITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 E MAIN ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980025643 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1534 BISHOP RD SW | ||||||||
| Address2: | |||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985127354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033572370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2015 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LF60928175 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.