Provider Demographics
NPI:1033680277
Name:PO, ELRICA MICHELLE DY
Entity Type:Individual
Prefix:
First Name:ELRICA MICHELLE
Middle Name:DY
Last Name:PO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 76TH ST. NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3720
Mailing Address - Country:US
Mailing Address - Phone:425-349-7313
Mailing Address - Fax:
Practice Address - Street 1:4308 76TH ST. NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3720
Practice Address - Country:US
Practice Address - Phone:425-349-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health