Provider Demographics
NPI:1801557665
Name:FU, ELISA MANAPAT (MSW, LICSWA)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MANAPAT
Last Name:FU
Suffix:
Gender:F
Credentials:MSW, LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 NE HIGHWAY 99 STE G1063
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8799
Mailing Address - Country:US
Mailing Address - Phone:360-524-4833
Mailing Address - Fax:360-326-9691
Practice Address - Street 1:6400 NE HIGHWAY 99 STE G1063
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8799
Practice Address - Country:US
Practice Address - Phone:360-524-4833
Practice Address - Fax:360-326-9691
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA614318581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health