1174954911 NPI number — MRS. SUSAN LOUISE KELSAY LMFTA

Table of content: MRS. SUSAN LOUISE KELSAY LMFTA (NPI 1174954911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174954911 NPI number — MRS. SUSAN LOUISE KELSAY LMFTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELSAY
Provider First Name:
SUSAN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174954911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 SE 124TH AVE.
Provider Second Line Business Mailing Address:
#203
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-524-4828
Provider Business Mailing Address Fax Number:
866-712-6982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 SE 124TH AVE.
Provider Second Line Business Practice Location Address:
#203
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-524-4828
Provider Business Practice Location Address Fax Number:
866-712-6982
Provider Enumeration Date:
12/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MG60416613 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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