Provider Demographics
NPI:1114370111
Name:WITEK, ELISE (MA LMHCA)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:WITEK
Suffix:
Gender:F
Credentials:MA LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 PINE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1216 PINE ST
Practice Address - Street 2:STE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1944
Practice Address - Country:US
Practice Address - Phone:206-323-1768
Practice Address - Fax:206-323-2184
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60559832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health