Provider Demographics
NPI:1114119948
Name:MCHENRY, ELLA G (CDP)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:G
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 I ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-2411
Mailing Address - Country:US
Mailing Address - Phone:253-661-6634
Mailing Address - Fax:253-735-4111
Practice Address - Street 1:33301 1ST WAY S
Practice Address - Street 2:STE C-115
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6252
Practice Address - Country:US
Practice Address - Phone:253-661-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)