Basic Information
| Provider Information | |||||||||
| NPI: | 1770888000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHINN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LMHC, CDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | M/S W-7831 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069874954 | ||||||||
| FaxNumber: | 2069873959 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | M/S W7831 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069874954 | ||||||||
| FaxNumber: | 2069873959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 01/18/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP 60028071 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LH00011230 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.