1174815401 NPI number — ANITA FAYE SNODGRASS GUSHURST M.A., LMHC, CDPT

Table of content: ANITA FAYE SNODGRASS GUSHURST M.A., LMHC, CDPT (NPI 1174815401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174815401 NPI number — ANITA FAYE SNODGRASS GUSHURST M.A., LMHC, CDPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUSHURST
Provider First Name:
ANITA
Provider Middle Name:
FAYE SNODGRASS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMHC, CDPT
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:
1174815401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14803 15TH AVE NE
Provider Second Line Business Mailing Address:
CENTER FOR HUMAN SERVICES
Provider Business Mailing Address City Name:
SHORELINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98155-7110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-499-9794
Provider Business Mailing Address Fax Number:
206-788-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21907 64TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-444-7900
Provider Business Practice Location Address Fax Number:
206-444-7910
Provider Enumeration Date:
05/04/2011

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: 101YM0800X , with the licence number:  LH60382513 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: LH60382513 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: CO60246524 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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