Provider Demographics
NPI:1063948347
Name:BASSEN, KAYLA JUNE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JUNE
Last Name:BASSEN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:JUNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5115 NE 94TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662
Mailing Address - Country:US
Mailing Address - Phone:971-381-0463
Mailing Address - Fax:360-266-5013
Practice Address - Street 1:5115 NE 94TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662
Practice Address - Country:US
Practice Address - Phone:360-558-7730
Practice Address - Fax:360-266-5013
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61228496101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health