Healthcare Provider Details

I. General information

NPI: 1518274703
Provider Name (Legal Business Name): ELIZABETH SMITH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 CARILLON PT
KIRKLAND WA
98033
US

IV. Provider business mailing address

15510 128TH CT NE
WOODINVILLE WA
98072
US

V. Phone/Fax

Practice location:
  • Phone: 425-301-1816
  • Fax: 425-949-3086
Mailing address:
  • Phone: 425-301-1816
  • Fax: 425-949-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60238712
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: