Provider Demographics
NPI:1871672949
Name:SOPER, ELLEN (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:SOPER
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LLP
Mailing Address - Street 1:10000 NE 7TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4542
Mailing Address - Country:US
Mailing Address - Phone:360-574-9565
Mailing Address - Fax:360-574-9685
Practice Address - Street 1:10000 NE 7TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4542
Practice Address - Country:US
Practice Address - Phone:360-574-9565
Practice Address - Fax:360-574-9685
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60051189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60051189OtherWASHINGTON DEPARTMENT OF HEALTH