Provider Demographics
NPI:1376149088
Name:CRESAP, AUSTIN RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:RAE
Last Name:CRESAP
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 22ND AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2308
Mailing Address - Country:US
Mailing Address - Phone:971-384-0775
Mailing Address - Fax:
Practice Address - Street 1:3411 22ND AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-2308
Practice Address - Country:US
Practice Address - Phone:971-384-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61502281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist