Provider Demographics
NPI:1700135548
Name:KLASSEN, MARTHA SUE (PSYD, BCBA)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:SUE
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:SUE
Other - Last Name:COOK KLASSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, BCBA
Mailing Address - Street 1:5212 KATELLA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6829
Mailing Address - Country:US
Mailing Address - Phone:714-490-3428
Mailing Address - Fax:562-493-1684
Practice Address - Street 1:5212 KATELLA AVE STE 104
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6829
Practice Address - Country:US
Practice Address - Phone:714-490-3428
Practice Address - Fax:562-493-1684
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CAPSY29865103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst