Provider Demographics
NPI:1740570969
Name:ELLSWORTH, CASSANDRA JOAN (LMFT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JOAN
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CJ
Other - Middle Name:
Other - Last Name:ELLSWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1811 156TH AVE NE STE 2
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4344
Mailing Address - Country:US
Mailing Address - Phone:425-460-7132
Mailing Address - Fax:425-460-7148
Practice Address - Street 1:1811 156TH AVE NE STE 2
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4344
Practice Address - Country:US
Practice Address - Phone:425-460-7132
Practice Address - Fax:425-460-7148
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60172289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist