Provider Demographics
NPI:1609767755
Name:LI, DE I (MR)
Entity type:Individual
Prefix:MR
First Name:DE
Middle Name:
Last Name:LI
Suffix:I
Gender:M
Credentials:MR
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MR
Mailing Address - Street 1:303 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-5314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303NE 103RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685
Practice Address - Country:US
Practice Address - Phone:360-281-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician