Provider Demographics
NPI:1063573145
Name:CANTRELL, ROSADA V (LMHC)
Entity type:Individual
Prefix:
First Name:ROSADA
Middle Name:V
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EAST OLIVE STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:16345 NE 87TH ST
Practice Address - Street 2:#A-6
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3503
Practice Address - Country:US
Practice Address - Phone:425-653-4960
Practice Address - Fax:425-653-4961
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009031101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health