Provider Demographics
NPI:1518318211
Name:MAIN EWING, LILY
Entity type:Individual
Prefix:MRS
First Name:LILY
Middle Name:
Last Name:MAIN EWING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10808 DIXON DR S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2719
Mailing Address - Country:US
Mailing Address - Phone:206-265-2836
Mailing Address - Fax:
Practice Address - Street 1:7131 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3316
Practice Address - Country:US
Practice Address - Phone:206-265-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2025-01-22
Deactivation Date:2018-07-21
Deactivation Code:
Reactivation Date:2025-01-22
Provider Licenses
StateLicense IDTaxonomies
WALH61228180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA111524501Medicaid