Provider Demographics
NPI:1164819397
Name:MCKEON, ELIZABETH (LMHCA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCKEON
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 98TH ST SE EVERETT
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-0569
Mailing Address - Country:US
Mailing Address - Phone:612-203-8890
Mailing Address - Fax:
Practice Address - Street 1:2322 98TH ST SE EVERETT
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-0569
Practice Address - Country:US
Practice Address - Phone:612-203-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-26
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101YA0400XMedicaid