Provider Demographics
NPI:1235409004
Name:MISSEL, CAROL RUTH (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:RUTH
Last Name:MISSEL
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:RUTH
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHCA
Mailing Address - Street 1:10116 MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3448
Mailing Address - Country:US
Mailing Address - Phone:206-319-4557
Mailing Address - Fax:206-319-4557
Practice Address - Street 1:10116 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3448
Practice Address - Country:US
Practice Address - Phone:206-319-4557
Practice Address - Fax:206-319-4557
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60169454101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional