Provider Demographics
NPI:1235284241
Name:GASSERT, MARY JANE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:GASSERT
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BURNETT AVE S # 207
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-2558
Mailing Address - Country:US
Mailing Address - Phone:206-920-2016
Mailing Address - Fax:425-430-8113
Practice Address - Street 1:321 BURNETT AVE S # 207
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2558
Practice Address - Country:US
Practice Address - Phone:206-920-2016
Practice Address - Fax:425-430-8113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist