Provider Demographics
NPI:1083196232
Name:MERCER ISLAND PSYCHOLOGY
Entity Type:Organization
Organization Name:MERCER ISLAND PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-709-2056
Mailing Address - Street 1:112 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6326
Mailing Address - Country:US
Mailing Address - Phone:310-709-2056
Mailing Address - Fax:
Practice Address - Street 1:2448 76TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2744
Practice Address - Country:US
Practice Address - Phone:310-709-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)