Provider Demographics
NPI:1821577933
Name:ELIZABETH WATT PSY D LLC
Entity Type:Organization
Organization Name:ELIZABETH WATT PSY D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-441-9515
Mailing Address - Street 1:1140 10TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7053
Mailing Address - Country:US
Mailing Address - Phone:630-363-1472
Mailing Address - Fax:844-621-7037
Practice Address - Street 1:1140 10TH ST STE 211
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7053
Practice Address - Country:US
Practice Address - Phone:630-363-1472
Practice Address - Fax:844-621-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60609307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2059830Medicaid