Provider Demographics
NPI:1104926708
Name:KUICK, LINDA SUE (MED LMHC NBCC CCJTS)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:KUICK
Suffix:
Gender:F
Credentials:MED LMHC NBCC CCJTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BRADLEY BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4498
Mailing Address - Country:US
Mailing Address - Phone:509-371-9956
Mailing Address - Fax:509-371-9957
Practice Address - Street 1:404 BRADLEY BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4498
Practice Address - Country:US
Practice Address - Phone:509-371-9956
Practice Address - Fax:509-371-9957
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003555101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA26508OtherCLINICALLY CERTIFIED JUVENILE TREATMENT SPECIALIST
51861OtherNATIONAL BOARD CERTIFICAT
WALH00003555OtherSTATE LICENSURE