Healthcare Provider Details

I. General information

NPI: 1700135548
Provider Name (Legal Business Name): MARTHA SUE KLASSEN PSYD, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA SUE COOK KLASSEN PSYD, BCBA

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 KATELLA AVE STE 104
LOS ALAMITOS CA
90720-6829
US

IV. Provider business mailing address

5212 KATELLA AVE STE 104
LOS ALAMITOS CA
90720-6829
US

V. Phone/Fax

Practice location:
  • Phone: 714-490-3428
  • Fax: 562-493-1684
Mailing address:
  • Phone: 714-490-3428
  • Fax: 562-493-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29865
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: