Healthcare Provider Details

I. General information

NPI: 1306097449
Provider Name (Legal Business Name): SYDNEY UPHAM SOELTER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N LAUREL ST STE 114
PORT ANGELES WA
98362-2637
US

IV. Provider business mailing address

PO BOX 2430
PORT ANGELES WA
98362-0311
US

V. Phone/Fax

Practice location:
  • Phone: 360-461-3126
  • Fax:
Mailing address:
  • Phone: 360-461-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH602248004
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: