Individual provider Active NPI

Earline Anderson, PH.D.

  • Counseling Psychologist
  • Issaquah, WA
National Provider Identifier
1013089192
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
PY00001412 Issued in WA
Practice address
55 1St PL NW
Issaquah, WA 98027-3271
Phone
(425) 392-0277
Fax
(425) 392-2509
NPI assigned
Nov 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X PY00001412 WA Primary

Addresses

Primary practice location

55 1St PL NW
Issaquah, WA 98027-3271

Mailing address

55 1St PL NW
Issaquah, WA 98027-3271
Phone (425) 392-0277

Other identifiers 2

IdentifierTypeStateIssuer
5284674OtherAETNA US HEALTHCARE ID
AN9961OtherREGENCE PIN #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150904000810 WA Practitioner - Clinical Psychologist 1456667476 Practice locations: Issaquah, WA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of Washington School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

22525 SE 64TH PL
Suite 238
Issaquah, WA 98027-5383
Phone (425) 503-3467

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY00001412WAMDCounseling Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013089192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 1ST PL NW",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980273271",
            "telephone_number": "425-392-0277",
            "fax_number": "425-392-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 1ST PL NW",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980273271",
            "telephone_number": "425-392-0277",
            "fax_number": "425-392-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "EARLINE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "WA",
            "license": "PY00001412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE ID",
            "identifier": "5284674",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE PIN #",
            "identifier": "AN9961",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

Verify at the official NPI Registry.