Provider Demographics
NPI:1265841241
Name:CHANG, ELIZABETH (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 5TH AVE NE STE 225
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7495
Mailing Address - Country:US
Mailing Address - Phone:929-352-4838
Mailing Address - Fax:
Practice Address - Street 1:10212 5TH AVE NE STE 225
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7495
Practice Address - Country:US
Practice Address - Phone:929-352-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001420106H00000X
WALF6102898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist