Provider Demographics
NPI:1508998477
Name:GROUT, SUSAN R (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:GROUT
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 GUARD ST.- P.O. BOX 2373
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-9665
Mailing Address - Country:US
Mailing Address - Phone:360-378-3212
Mailing Address - Fax:
Practice Address - Street 1:580 GUARD ST
Practice Address - Street 2:SUITE A
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8044
Practice Address - Country:US
Practice Address - Phone:360-378-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health