Provider Demographics
NPI:1861249476
Name:TAMRU, ELBETEL
Entity type:Individual
Prefix:
First Name:ELBETEL
Middle Name:
Last Name:TAMRU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9814 NE 190TH ST APT C201
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2956
Mailing Address - Country:US
Mailing Address - Phone:425-791-2853
Mailing Address - Fax:
Practice Address - Street 1:14524 MAIN ST NE STE 111
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8467
Practice Address - Country:US
Practice Address - Phone:206-670-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5874OtherHEALTHCARE PARTNERS