Provider Demographics
NPI:1205435120
Name:EZELL, ELIZABETH A (LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:EZELL
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 S MASON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-1642
Mailing Address - Country:US
Mailing Address - Phone:253-579-5718
Mailing Address - Fax:949-577-4199
Practice Address - Street 1:4002 S M ST STE G
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-3800
Practice Address - Country:US
Practice Address - Phone:253-579-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609069161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical