1598072019 NPI number — DON ELLE LMFT CDP

Table of content: DON ELLE LMFT CDP (NPI 1598072019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598072019 NPI number — DON ELLE LMFT CDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLE
Provider First Name:
DON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT CDP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598072019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6513 132ND AVE NE
Provider Second Line Business Mailing Address:
#107
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98033-8628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-221-8275
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 130TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-221-8275
Provider Business Practice Location Address Fax Number:
425-867-5045
Provider Enumeration Date:
09/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LF60098310 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: CPO60143886 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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