Provider Demographics
NPI:1124477252
Name:MICHAEL AQUILINO, M.S., L.M.H.C., P.L.L.C.
Entity type:Organization
Organization Name:MICHAEL AQUILINO, M.S., L.M.H.C., P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUILINO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-480-0744
Mailing Address - Street 1:1111 W SPRUCE ST
Mailing Address - Street 2:SUITE 32
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3257
Mailing Address - Country:US
Mailing Address - Phone:509-480-0744
Mailing Address - Fax:509-966-2645
Practice Address - Street 1:1111 W SPRUCE ST
Practice Address - Street 2:SUITE 32
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3257
Practice Address - Country:US
Practice Address - Phone:509-480-0744
Practice Address - Fax:509-966-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60536655101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty