Provider Demographics
NPI:1952674145
Name:CHANG, HAN-MAE ELLA
Entity Type:Individual
Prefix:
First Name:HAN-MAE
Middle Name:ELLA
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 ROOSEVELT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6228
Mailing Address - Country:US
Mailing Address - Phone:206-395-5848
Mailing Address - Fax:206-363-9639
Practice Address - Street 1:11320 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6228
Practice Address - Country:US
Practice Address - Phone:206-395-5848
Practice Address - Fax:206-363-9639
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60422207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health