Healthcare Provider Details

I. General information

NPI: 1770646762
Provider Name (Legal Business Name): ELLEN LOUISE BEAUCHAMP PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/05/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10047 MAIN ST APT 310
BELLEVUE WA
98004-5317
US

IV. Provider business mailing address

10047 MAIN ST APT 310
BELLEVUE WA
98004-5317
US

V. Phone/Fax

Practice location:
  • Phone: 425-269-1218
  • Fax:
Mailing address:
  • Phone: 425-269-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1418
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY202216
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1519
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY6649
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2413
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY810001654
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC6202
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY2413
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: