Provider Demographics
NPI:1497178206
Name:SNOHOMISH PSYCHOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SNOHOMISH PSYCHOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUSETH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-789-1073
Mailing Address - Street 1:PO BOX 13221
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-3221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1721 HEWITT AVE
Practice Address - Street 2:SUITE 416
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3570
Practice Address - Country:US
Practice Address - Phone:425-789-1073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60073218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty