Provider Demographics
NPI:1104284819
Name:MOSER, SUSAN (LMHCA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MOSER
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30150 3RD PL SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3907
Mailing Address - Country:US
Mailing Address - Phone:206-304-8215
Mailing Address - Fax:
Practice Address - Street 1:31919 1ST AVE S
Practice Address - Street 2:SUITE 203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5236
Practice Address - Country:US
Practice Address - Phone:253-839-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60590923101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor