Provider Demographics
NPI:1437154150
Name:MUSAZADE, SUSEN IRENE (MS, LMHC, LMFT)
Entity type:Individual
Prefix:
First Name:SUSEN
Middle Name:IRENE
Last Name:MUSAZADE
Suffix:
Gender:F
Credentials:MS, LMHC, LMFT
Other - Prefix:
Other - First Name:SUSEN
Other - Middle Name:IRENE
Other - Last Name:BRUMBAUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1424 NE 155TH ST
Mailing Address - Street 2:STE 208
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7104
Mailing Address - Country:US
Mailing Address - Phone:206-440-3198
Mailing Address - Fax:206-440-0060
Practice Address - Street 1:1424 NE 155TH ST
Practice Address - Street 2:STE 208
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7104
Practice Address - Country:US
Practice Address - Phone:206-440-3198
Practice Address - Fax:206-440-0060
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health