Provider Demographics
NPI:1235574377
Name:KIRSCH, SUZANNE M (MSLMFT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MSLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 462
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333
Mailing Address - Country:US
Mailing Address - Phone:206-399-9482
Mailing Address - Fax:
Practice Address - Street 1:5262 OLYMPIC DR NW STE A
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1795
Practice Address - Country:US
Practice Address - Phone:206-399-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00001944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist