Provider Demographics
NPI:1558101345
Name:FELTS, RAISA (PSYD)
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:FELTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 NE 8TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3960
Mailing Address - Country:US
Mailing Address - Phone:425-616-1261
Mailing Address - Fax:
Practice Address - Street 1:16301 NE 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3960
Practice Address - Country:US
Practice Address - Phone:425-616-1261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61104244101YM0800X
WA61104244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health