Provider Demographics
NPI:1427454503
Name:CASPE-DETZER, ARIEL
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:CASPE-DETZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 112TH AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2953
Mailing Address - Country:US
Mailing Address - Phone:425-452-8036
Mailing Address - Fax:
Practice Address - Street 1:2227 112TH AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2953
Practice Address - Country:US
Practice Address - Phone:425-452-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60489768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health