Provider Demographics
NPI:1043459688
Name:M. SUE CHENOWETH, PSYD, LLC
Entity Type:Organization
Organization Name:M. SUE CHENOWETH, PSYD, LLC
Other - Org Name:MARCIA SUE CHENOWETH
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CHENOWETH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-696-2744
Mailing Address - Street 1:200 E 22ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3266
Mailing Address - Country:US
Mailing Address - Phone:360-696-2744
Mailing Address - Fax:360-696-4811
Practice Address - Street 1:200 E 22ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3266
Practice Address - Country:US
Practice Address - Phone:360-696-2744
Practice Address - Fax:360-696-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty