Basic Information
| Provider Information | |||||||||
| NPI: | 1154480457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUTH | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1022, | ||||||||
| Address2: | 375 NE WAUNA AVE | ||||||||
| City: | WHITE SALMON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414907695 | ||||||||
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| Practice Location | |||||||||
| Address1: | 683 SW ROCK CREEK DR. | ||||||||
| Address2: | |||||||||
| City: | STEVENSON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094273850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00008158 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.