Active NPI
Robert Glenn Lack III, MA, CDP
- Addiction (Substance Use Disorder) Counselor
- Kennewick, WA
National Provider Identifier
1386877389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CP-00001417
- Practice address
- 1010 E Bruneau Ave
Kennewick, WA 99336-3775 - Phone
- (509) 735-7410
- Fax
- (509) 783-5953
- NPI assigned
- Aug 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | RC-00018500 | WA | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CP-00001417 | WA | Primary |
Addresses
Primary practice location
1010 E Bruneau Ave
Kennewick, WA 99336-3775
Mailing address
PO Box 5697
Kennewick, WA 99336-0697
Phone (509) 735-7410
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RC-00018500 | WA | MD | Counselor |
| CP-00001417 | WA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Action Counseling | Addiction (Substance Use Disorder) | Past | Accepting new patients |
| Action Counseling | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Kennewick, WA
- NPI 1205241106
-
- Addiction (Substance Use Disorder) Counselor
- Kennewick, WA
- NPI 1922356906
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251158400000",
"number": "1386877389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5697",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993360697",
"telephone_number": "509-735-7410",
"fax_number": "509-783-5953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 E BRUNEAU AVE",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993363775",
"telephone_number": "509-735-7410",
"fax_number": "509-783-5953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACK",
"first_name": "ROBERT",
"middle_name": "GLENN",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "MA, CDP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-25",
"last_updated": "2009-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "RC-00018500",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CP-00001417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennewick, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.