Basic Information
Provider Information
NPI: 1003002536
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURNS
FirstName: SUSAN
MiddleName: BEGIN
NamePrefix:  
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BEGIN-BURNS
OtherFirstName: SUSAN
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.A
OtherLastNameType: 5
Mailing Information
Address1: 2370 130TH AVE NE STE 106
Address2:  
City: BELLEVUE
State: WA
PostalCode: 980051770
CountryCode: US
TelephoneNumber: 4258819000
FaxNumber: 4257468016
Practice Location
Address1: 2370 130TH AVE NE STE 106
Address2:  
City: BELLEVUE
State: WA
PostalCode: 980051770
CountryCode: US
TelephoneNumber: 4258819000
FaxNumber: 4257468016
Other Information
ProviderEnumerationDate: 09/18/2007
LastUpdateDate: 09/18/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XLH00003581WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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