MEDICARE: ELICE AUGUST PRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	25-QMHA-R-7735

General Provider Information

NPI Number	:	1437082427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELICE AUGUST PRAY

Provider Business Mailing Address
First Line	:	6841 49TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-7734
Country	:	US
Telephone Number	:	206-595-6486
Fax Number	:

Provider Business Practice Location Address
First Line	:	4943 NE MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3511
Country	:	US
Telephone Number	:	971-292-1960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ ELICE AUGUST PRAY ” Practice Location

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