Provider Demographics
NPI:1386966745
Name:MIDDLETON, RICHARD THOMAS (LICENSED MENTAL HEAL)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:THOMAS
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:LICENSED MENTAL HEAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8396 NE BLAKELY HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3200
Mailing Address - Country:US
Mailing Address - Phone:206-842-2022
Mailing Address - Fax:
Practice Address - Street 1:945 HILDEBRAND LANE NE
Practice Address - Street 2:SUITE #210
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3200
Practice Address - Country:US
Practice Address - Phone:206-842-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003690101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor