Provider Demographics
NPI:1518319904
Name:DAUM, ELLYSSA (PSYD)
Entity Type:Individual
Prefix:
First Name:ELLYSSA
Middle Name:
Last Name:DAUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 37TH ST SE TRLR 130
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8852
Mailing Address - Country:US
Mailing Address - Phone:206-595-1875
Mailing Address - Fax:
Practice Address - Street 1:8301 161ST AVE NE STE 202
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-900-6134
Practice Address - Fax:425-968-5619
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMC.61544070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program