Healthcare Provider Details

I. General information

NPI: 1518319904
Provider Name (Legal Business Name): ELLYSSA DAUM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33455 6TH AVE S STE 2C
FEDERAL WAY WA
98003-6074
US

IV. Provider business mailing address

14953 WALLACE AVE E
BONNEY LAKE WA
98391-1400
US

V. Phone/Fax

Practice location:
  • Phone: 253-210-4230
  • Fax:
Mailing address:
  • Phone: 206-595-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC.61544070
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: