Basic Information
| Provider Information | |||||||||
| NPI: | 1740653989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASHUBA | ||||||||
| FirstName: | KORRIE | ||||||||
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| Credential: | IMF | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2429 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986328486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603539494 | ||||||||
| FaxNumber: | 3603539440 | ||||||||
| Practice Location | |||||||||
| Address1: | 922 FIR ST | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603539422 | ||||||||
| FaxNumber: | 3603539440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2015 | ||||||||
| LastUpdateDate: | 02/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 79410 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 60946487 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.