Provider Demographics
NPI:1265949234
Name:STCLAIR, ELIZABETH NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:STCLAIR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY SUITE 100
Mailing Address - Street 2:PMB 94974
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1407
Mailing Address - Country:US
Mailing Address - Phone:319-541-3659
Mailing Address - Fax:
Practice Address - Street 1:3757 FREIGHTER PL
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-5503
Practice Address - Country:US
Practice Address - Phone:360-830-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPY60881040103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program