Provider Demographics
NPI:1104345305
Name:FRAZE, REBECCA S (LMHC, SUDP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:FRAZE
Suffix:
Gender:F
Credentials:LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 216TH ST SW STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2089
Mailing Address - Country:US
Mailing Address - Phone:503-397-1912
Mailing Address - Fax:
Practice Address - Street 1:2154 OREGON ST UNIT 54
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1387
Practice Address - Country:US
Practice Address - Phone:503-397-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALC61463859101YP2500X
WACP60315129101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101YA0400XMedicaid