Healthcare Provider Details

I. General information

NPI: 1194862425
Provider Name (Legal Business Name): ELLIOTT BAY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BROADWAY #313
SEATTLE WA
98122-4397
US

IV. Provider business mailing address

1001 BROADWAY #313
SEATTLE WA
98122-4397
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-0860
  • Fax: 206-860-2829
Mailing address:
  • Phone: 206-860-0860
  • Fax: 206-860-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BEN LOW
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 206-860-0860