Provider Demographics
NPI:1083963912
Name:ELLER, SUZANNA L (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNA
Middle Name:L
Last Name:ELLER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 SW CLOVERDALE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2250
Mailing Address - Country:US
Mailing Address - Phone:206-286-1888
Mailing Address - Fax:
Practice Address - Street 1:2507 SW CLOVERDALE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2250
Practice Address - Country:US
Practice Address - Phone:206-286-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health