Provider Demographics
NPI:1043441793
Name:SUESS, VIRGIL RAYMOND JR (MFT)
Entity Type:Individual
Prefix:MR
First Name:VIRGIL
Middle Name:RAYMOND
Last Name:SUESS
Suffix:JR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 E BAKERVIEW RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8179
Mailing Address - Country:US
Mailing Address - Phone:360-676-9535
Mailing Address - Fax:360-733-4339
Practice Address - Street 1:192 E BAKERVIEW RD
Practice Address - Street 2:SUITE #102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8179
Practice Address - Country:US
Practice Address - Phone:360-676-9535
Practice Address - Fax:360-733-4339
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist