Provider Demographics
NPI:1023386364
Name:VISAN, CARMEN-ECATERINA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CARMEN-ECATERINA
Middle Name:
Last Name:VISAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:ECATERINA
Other - Last Name:VISAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:421 N PEARL ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3193
Mailing Address - Country:US
Mailing Address - Phone:509-925-2114
Mailing Address - Fax:509-925-2115
Practice Address - Street 1:421 N PEARL ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3193
Practice Address - Country:US
Practice Address - Phone:509-925-2114
Practice Address - Fax:509-925-2115
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60202825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health