Healthcare Provider Details

I. General information

NPI: 1972369247
Provider Name (Legal Business Name): ELIZABETH BLUMHORST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 SW JUNEAU ST
SEATTLE WA
98136-1621
US

IV. Provider business mailing address

5214 RAINIER AVE S APT 102
SEATTLE WA
98118-6140
US

V. Phone/Fax

Practice location:
  • Phone: 206-207-5395
  • Fax:
Mailing address:
  • Phone: 925-550-3794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: