Individual provider Active NPI

Anthonie Ontreay Etienne, LMFT

  • Marriage & Family Therapist
  • Puyallup, WA
National Provider Identifier
1023428117
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LF61658464 Issued in WA
Practice address
3911 9TH St SW Ste 205
Puyallup, WA 98373-5946
Phone
(760) 881-5559
Fax
(442) 255-1126
NPI assigned
Apr 29, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X
Marriage & Family Therapist 106H00000X LMFT138474 CA
Marriage & Family Therapist 106H00000X LF61658464 WA Primary
Pastoral Counselor 101YP1600X

Addresses

Primary practice location

3911 9TH St SW Ste 205
Puyallup, WA 98373-5946

Mailing address

PO Box 731915
Puyallup, WA 98373-0045
Phone (442) 348-3822

Other identifiers 1

IdentifierTypeStateIssuer
2335703MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240625003048 CA Practitioner - Marriage and Family Therapist 6608319199 Reassigns benefits to 1 organization
I20250624001017 WA Practitioner - Marriage and Family Therapist 6608319199 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMFT138474CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Calm in the Wilderness Ministries Marriage & Family Therapist CurrentSince Aug 17, 2025 Accepting new patients
Calm in the Wilderness Marriage & Family Therapist CurrentSince Apr 29, 2025 Accepting new patients
County of San Bernardino PastSince May 22, 2022 Accepting new patients

Locations

14201 Kentwood Blvd
Ste 2
Victorville, CA 92392
Phone (760) 253-1834

3911 9th St SW
Ste 205
Puyallup, WA 98373
Phone (760) 881-5559

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778716800000",
    "number": "1023428117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 731915",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983730045",
            "telephone_number": "442-348-3822",
            "fax_number": "442-255-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3911 9TH ST SW STE 205",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983735946",
            "telephone_number": "760-881-5559",
            "fax_number": "442-255-1126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "ANTHONIE",
        "middle_name": "ONTREAY",
        "name_prefix": "Mr.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-29",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT138474",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF61658464",
            "primary": true
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2335703",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.