Provider Demographics
NPI:1558747543
Name:SOUKUP, ELLEN (MS, PHD)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:SOUKUP
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 NATIVIDAD ROAD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901
Mailing Address - Country:US
Mailing Address - Phone:831-796-1500
Mailing Address - Fax:
Practice Address - Street 1:17825 59TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6453
Practice Address - Country:US
Practice Address - Phone:360-363-4234
Practice Address - Fax:360-363-4235
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60945604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty