Provider Demographics
NPI:1942806724
Name:TORJUSSEN, ASE (SUDP)
Entity Type:Individual
Prefix:
First Name:ASE
Middle Name:
Last Name:TORJUSSEN
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SE WHITENER RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7747
Mailing Address - Country:US
Mailing Address - Phone:360-426-1582
Mailing Address - Fax:
Practice Address - Street 1:100 SE WHITENER RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-7747
Practice Address - Country:US
Practice Address - Phone:360-426-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60114316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)