Ellen Soukup, MS, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY60945604 Issued in WA

Practice address

17825 59TH Ave NE Ste B
Arlington, WA 98223-6453

Phone

(360) 363-4234

Fax

(360) 363-4235

NPI assigned

Aug 3, 2015

Last updated

Feb 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 19, 2025 through May 19, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Openworld Psychology Inc

  dba OpenWorld Psychology, PC

  • Clinical Psychologist
  • Everett, WA
  • NPI 1437870060
  NPD (past)

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

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1558747543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 NATIVIDAD ROAD",
            "city": "SALINAS",
            "state": "CA",
            "postal_code": "93901",
            "telephone_number": "831-796-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17825 59TH AVE NE STE B",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982236453",
            "telephone_number": "360-363-4234",
            "fax_number": "360-363-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUKUP",
        "first_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "MS, PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-03",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60945604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Arlington, WA
• Providers in Arlington, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.