Active NPI
Ann Christine Theriault, M.ED.
- Mental Health Counselor
- Othello, WA
National Provider Identifier
1063850352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CG60374065
- Practice address
- 425 E Main St
Othello, WA 99344-1146 - Phone
- (509) 488-5611
- NPI assigned
- Jun 7, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CG60374065 | WA | Primary |
Addresses
Primary practice location
425 E Main St
Othello, WA 99344-1146
Mailing address
425 E Main St
Othello, WA 99344-1146
Phone (509) 488-5611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60374065 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370563200000",
"number": "1063850352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 E MAIN ST",
"city": "OTHELLO",
"state": "WA",
"postal_code": "993441146",
"telephone_number": "509-488-5611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 E MAIN ST",
"city": "OTHELLO",
"state": "WA",
"postal_code": "993441146",
"telephone_number": "509-488-5611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THERIAULT",
"first_name": "ANN",
"middle_name": "CHRISTINE",
"credential": "M.ED.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-07",
"last_updated": "2013-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "CG60374065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Othello, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.