Provider Demographics
NPI:1770816811
Name:MAUSETH, KIRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:
Last Name:MAUSETH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 HEWITT AVE
Mailing Address - Street 2:SUITE 416
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3570
Mailing Address - Country:US
Mailing Address - Phone:425-789-1073
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:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60073218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist