Provider Demographics
NPI:1114328630
Name:REDD, CARESS AZZURRA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:CARESS
Middle Name:AZZURRA
Last Name:REDD
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 1:13105 PINTO LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6741
Mailing Address - Country:US
Mailing Address - Phone:206-422-0096
Mailing Address - Fax:
Practice Address - Street 1:8201 164TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7615
Practice Address - Country:US
Practice Address - Phone:206-422-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC3333Medicare PIN