Provider Demographics
NPI:1104331172
Name:MARSHALL, ELIZABETH SUSANNE SILTMAN (LMHCA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSANNE SILTMAN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 N WHITMAN ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1714
Mailing Address - Country:US
Mailing Address - Phone:253-254-4877
Mailing Address - Fax:
Practice Address - Street 1:4247 N WHITMAN ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-1714
Practice Address - Country:US
Practice Address - Phone:253-254-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60753452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC60753452OtherDEPARTMENT OF HEALTH WASHINGTON STATE