Provider Demographics
NPI:1750084562
Name:ELBERTSON, LITA
Entity type:Individual
Prefix:
First Name:LITA
Middle Name:
Last Name:ELBERTSON
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 1:102 30TH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6206
Mailing Address - Country:US
Mailing Address - Phone:808-937-2230
Mailing Address - Fax:
Practice Address - Street 1:102 30TH AVE APT B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6206
Practice Address - Country:US
Practice Address - Phone:808-937-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health