Provider Demographics
NPI:1255921284
Name:SEELBACH, EMILY MARIE (CBT, LABA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:SEELBACH
Suffix:
Gender:F
Credentials:CBT, LABA
Other - Prefix:
Other - First Name:EMMI
Other - Middle Name:MARIE
Other - Last Name:SEELBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CBT, LABA
Mailing Address - Street 1:4301 S TACOMA WAY # WA98409
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4522
Mailing Address - Country:US
Mailing Address - Phone:253-292-4354
Mailing Address - Fax:855-373-4004
Practice Address - Street 1:4301 S TACOMA WAY # WA98409
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4522
Practice Address - Country:US
Practice Address - Phone:253-292-4354
Practice Address - Fax:855-373-4004
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABACB553866106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician