Provider Demographics
NPI:1154891588
Name:BASTIDA, RACHEL DIANE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:BASTIDA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DIANE
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21907 64TH AVE W STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-6200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2311 SW 352ND ST APT B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-3178
Practice Address - Country:US
Practice Address - Phone:253-368-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60695040101YM0800X
WALH61021343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health