Provider Demographics
NPI:1235889387
Name:LUI-DOAN, ETHAN DUONG
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:DUONG
Last Name:LUI-DOAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 SE 192ND AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1471
Mailing Address - Country:US
Mailing Address - Phone:360-605-1881
Mailing Address - Fax:
Practice Address - Street 1:4101 SE 192ND AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1471
Practice Address - Country:US
Practice Address - Phone:360-605-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician