Healthcare Provider Details

I. General information

NPI: 1790363729
Provider Name (Legal Business Name): ELLIOT GRAYSON COLLINS MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 EASTLAKE AVE E STE 115
SEATTLE WA
98102-3084
US

IV. Provider business mailing address

2825 EASTLAKE AVE E STE 115
SEATTLE WA
98102-3084
US

V. Phone/Fax

Practice location:
  • Phone: 206-705-3509
  • Fax: 206-704-3822
Mailing address:
  • Phone: 206-705-3509
  • Fax: 206-704-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.MD.61566443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: