Healthcare Provider Details

I. General information

NPI: 1558224733
Provider Name (Legal Business Name): ELSA J ALVARADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 336TH ST STE 102
FEDERAL WAY WA
98003-6389
US

IV. Provider business mailing address

500 S 336TH ST STE 102
FEDERAL WAY WA
98003-6389
US

V. Phone/Fax

Practice location:
  • Phone: 253-293-3149
  • Fax:
Mailing address:
  • Phone: 253-293-3149
  • Fax: 323-975-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: