Provider Demographics
NPI:1669434528
Name:HENDRICKS, ELIZABETH PATRICIA (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:PATRICIA
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:QUILCENE
Mailing Address - State:WA
Mailing Address - Zip Code:98376-0775
Mailing Address - Country:US
Mailing Address - Phone:360-385-3699
Mailing Address - Fax:360-765-3626
Practice Address - Street 1:294843 US HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:QUILCENE
Practice Address - State:WA
Practice Address - Zip Code:98376-6000
Practice Address - Country:US
Practice Address - Phone:360-385-3699
Practice Address - Fax:360-765-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health