Provider Demographics
NPI:1306274931
Name:REALITY CONCEPTS
Entity type:Organization
Organization Name:REALITY CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:R GARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:RETALLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:360-471-4398
Mailing Address - Street 1:707 SIDNEY PKWY
Mailing Address - Street 2:#14
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5318
Mailing Address - Country:US
Mailing Address - Phone:360-471-4398
Mailing Address - Fax:
Practice Address - Street 1:707 SIDNEY PKWY UNIT 14
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5318
Practice Address - Country:US
Practice Address - Phone:360-471-4398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60344426251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health