Provider Demographics
NPI:1316701196
Name:BASBALLE, MARJORIE R (LMHCA)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:R
Last Name:BASBALLE
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 1:15623 296TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-9027
Mailing Address - Country:US
Mailing Address - Phone:253-318-5179
Mailing Address - Fax:
Practice Address - Street 1:15623 296TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-9027
Practice Address - Country:US
Practice Address - Phone:253-318-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health