Provider Demographics
NPI:1316235302
Name:FELL, EMILY CLAIRE (LICSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CLAIRE
Last Name:FELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:734-926-9203
Mailing Address - Fax:
Practice Address - Street 1:6400 SOUTHCENTER BLVD
Practice Address - Street 2:200
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2547
Practice Address - Country:US
Practice Address - Phone:206-444-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60327784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616824OtherBLUE CROSS BLUE SHIELD