Provider Demographics
NPI:1205955390
Name:KASSUHN, BETTY C (CDP)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:C
Last Name:KASSUHN
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 PROSPECT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5330
Mailing Address - Country:US
Mailing Address - Phone:360-895-1307
Mailing Address - Fax:
Practice Address - Street 1:729 PROSPECT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5330
Practice Address - Country:US
Practice Address - Phone:360-895-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00041017101YA0400X
WACP00004989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)