Provider Demographics
NPI:1952023376
Name:VANTASSEL, KATHERINE LEBO (LMFTA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEBO
Last Name:VANTASSEL
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LINDEN AVE N APT 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7259
Mailing Address - Country:US
Mailing Address - Phone:650-678-3824
Mailing Address - Fax:
Practice Address - Street 1:3560 BRIDGEPORT WAY W STE 2C
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4446
Practice Address - Country:US
Practice Address - Phone:253-460-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist