Provider Demographics
NPI:1154480457
Name:MUTH, SUSAN ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:MUTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1022,
Mailing Address - Street 2:375 NE WAUNA AVE
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672
Mailing Address - Country:US
Mailing Address - Phone:541-490-7695
Mailing Address - Fax:
Practice Address - Street 1:683 SW ROCK CREEK DR.
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648
Practice Address - Country:US
Practice Address - Phone:509-427-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health