Healthcare Provider Details

I. General information

NPI: 1336774975
Provider Name (Legal Business Name): EILEEN SCHOLTZ CO61027498
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 JAMES ST
SEATTLE WA
98104-5102
US

IV. Provider business mailing address

921 HARVEY RD NE STE C
AUBURN WA
98002-4294
US

V. Phone/Fax

Practice location:
  • Phone: 206-464-6454
  • Fax: 206-652-1236
Mailing address:
  • Phone: 253-939-2211
  • Fax: 253-939-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number61027498
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61346335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: