Provider Demographics
NPI:1497895429
Name:FARSJE, IRENE M (MA)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:M
Last Name:FARSJE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65402
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-1402
Mailing Address - Country:US
Mailing Address - Phone:253-380-1399
Mailing Address - Fax:866-648-3021
Practice Address - Street 1:1919 70TH AVE W STE D
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5541
Practice Address - Country:US
Practice Address - Phone:253-380-1399
Practice Address - Fax:253-380-1399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health