Provider Demographics
NPI:1174815401
Name:GUSHURST, ANITA FAYE SNODGRASS (MA, LMHC, CDPT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:FAYE SNODGRASS
Last Name:GUSHURST
Suffix:
Gender:F
Credentials:MA, LMHC, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14803 15TH AVE NE
Mailing Address - Street 2:CENTER FOR HUMAN SERVICES
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7110
Mailing Address - Country:US
Mailing Address - Phone:206-499-9794
Mailing Address - Fax:206-788-3902
Practice Address - Street 1:21907 64TH AVE W
Practice Address - Street 2:SUITE 240
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2200
Practice Address - Country:US
Practice Address - Phone:206-444-7900
Practice Address - Fax:206-444-7910
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60382513101YM0800X, 101Y00000X
WACO60246524390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program