Healthcare Provider Details

I. General information

NPI: 1306357702
Provider Name (Legal Business Name): KAISA HUHTA BSW, CAAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 14TH AVE
LONGVIEW WA
98632-2316
US

IV. Provider business mailing address

921 14TH AVE
LONGVIEW WA
98632-2316
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-6064
  • Fax: 360-423-5277
Mailing address:
  • Phone: 360-423-0203
  • Fax: 360-577-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60800853
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: