Provider Demographics
NPI:1174988554
Name:HARRIS, SUSAN PAULINE (LMHC, NCGC II, CDP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PAULINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMHC, NCGC II, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SW 2ND ST APT 17
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9448
Mailing Address - Country:US
Mailing Address - Phone:360-840-5918
Mailing Address - Fax:
Practice Address - Street 1:1600 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3802
Practice Address - Country:US
Practice Address - Phone:360-840-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP0000123101YA0400X
WALH60607921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)