Healthcare Provider Details

I. General information

NPI: 1508337064
Provider Name (Legal Business Name): ELIZABETH ROSE TAETS VON AMERONGEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ROSE SIERRA WILLIAMS

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HARRISON AVE UNIT 131
BLAINE WA
98231-7006
US

IV. Provider business mailing address

701 HARRISON AVE UNIT 131
BLAINE WA
98231-7006
US

V. Phone/Fax

Practice location:
  • Phone: 929-399-3414
  • Fax:
Mailing address:
  • Phone: 929-399-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61093280
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5091
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0017007
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74902
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: