Provider Demographics
NPI:1598153207
Name:LEVERIDGE, SUSAN K (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:LEVERIDGE
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 1:8226 BRACKEN PL SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9235
Mailing Address - Country:US
Mailing Address - Phone:206-930-2238
Mailing Address - Fax:
Practice Address - Street 1:8226 BRACKEN PL SE STE 200
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9235
Practice Address - Country:US
Practice Address - Phone:206-930-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-03
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60551031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health