Provider Demographics
NPI:1932617693
Name:GOLOSINSKIY, RICHARD MARK (LMHC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:GOLOSINSKIY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5264 NE 121ST AVE APT 79
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2179
Mailing Address - Country:US
Mailing Address - Phone:360-712-3756
Mailing Address - Fax:360-712-3755
Practice Address - Street 1:327 NE 5TH AVE STE B
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2030
Practice Address - Country:US
Practice Address - Phone:360-712-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2025-01-08
Deactivation Date:2018-06-09
Deactivation Code:
Reactivation Date:2018-06-20
Provider Licenses
StateLicense IDTaxonomies
WALH61487896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty