Provider Demographics
NPI:1841341831
Name:SUGARMAN, CAROLYN LOUISE (LMHC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:SUGARMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 DILLEY RD
Mailing Address - Street 2:
Mailing Address - City:TIETON
Mailing Address - State:WA
Mailing Address - Zip Code:98947-9719
Mailing Address - Country:US
Mailing Address - Phone:509-673-6151
Mailing Address - Fax:
Practice Address - Street 1:411 S 12TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3109
Practice Address - Country:US
Practice Address - Phone:509-577-7100
Practice Address - Fax:509-577-7900
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health