Provider Demographics
NPI:1992594394
Name:PRATER, ELIJAH WILLIAM
Entity type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:WILLIAM
Last Name:PRATER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27934 122ND PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-8531
Mailing Address - Country:US
Mailing Address - Phone:425-748-4883
Mailing Address - Fax:
Practice Address - Street 1:25530 74TH AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6014
Practice Address - Country:US
Practice Address - Phone:206-793-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician