Provider Demographics
NPI:1598130049
Name:ELLIS, SANDRA SUE (LMHCA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:ELLIS
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 1:20102 CEDAR VALLEY RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6333
Mailing Address - Country:US
Mailing Address - Phone:425-367-3368
Mailing Address - Fax:425-771-8400
Practice Address - Street 1:20102 CEDAR VALLEY RD STE 106
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6333
Practice Address - Country:US
Practice Address - Phone:425-367-3368
Practice Address - Fax:425-771-8400
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60318861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health