Provider Demographics
NPI:1730587635
Name:DE CORIOLIS, PAULETTE ELLEN (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:ELLEN
Last Name:DE CORIOLIS
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15600 REDMOND WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3862
Mailing Address - Country:US
Mailing Address - Phone:425-417-3525
Mailing Address - Fax:
Practice Address - Street 1:15600 REDMOND WAY STE 201
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3862
Practice Address - Country:US
Practice Address - Phone:425-417-3525
Practice Address - Fax:425-881-8481
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60620693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health