Provider Demographics
NPI:1306083225
Name:BELL, PATRICIA LISA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LISA
Last Name:BELL
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 1:83 WINDDANCER LN
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-8319
Mailing Address - Country:US
Mailing Address - Phone:360-565-2631
Mailing Address - Fax:360-457-4875
Practice Address - Street 1:1912 W 18TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-5121
Practice Address - Country:US
Practice Address - Phone:360-565-2621
Practice Address - Fax:360-457-4875
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005916101YA0400X
WALH00010762101YM0800X
WALF00002412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1326139528Medicaid