Provider Demographics
NPI:1700135548
Name:KLASSEN, MARTHA SUE (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:SUE
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:SUE
Other - Last Name:COOK KLASSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, BCBA-D
Mailing Address - Street 1:2082 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1129
Mailing Address - Country:US
Mailing Address - Phone:949-250-1101
Mailing Address - Fax:949-250-1103
Practice Address - Street 1:2082 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1129
Practice Address - Country:US
Practice Address - Phone:949-250-1101
Practice Address - Fax:949-250-1103
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst